availity Claim Status API

openapi: 3.1.0
info:
  title: Availity Claim Attachments Auth Attachments Claim Status API
  description: The Availity Claim Attachments API enables electronic submission of supporting documentation alongside healthcare claims.
  version: 1.0.0
  contact:
    name: Availity Developer Portal
    url: https://developer.availity.com/
servers:
- url: https://api.availity.com
  description: Availity Production API
security:
- oauth2: []
tags:
- name: Claim Status
  description: Claim status inquiries and tracking
paths:
  /availity/intelligent-payer-network/v1/claim-statuses:
    post:
      operationId: createClaimStatusInquiry
      summary: Availity Create Claim Status Inquiry
      description: Submit a claim status inquiry (equivalent to X12 276 transaction). Returns claim status and adjudication information.
      tags:
      - Claim Status
      x-microcks-operation:
        delay: 0
        dispatcher: FALLBACK
      requestBody:
        required: true
        content:
          application/json:
            schema:
              $ref: '#/components/schemas/ClaimStatusRequest'
      responses:
        '200':
          description: Claim status response
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/ClaimStatusResponse'
              examples:
                CreateClaimStatusInquiry200Example:
                  summary: Default createClaimStatusInquiry 200 response
                  x-microcks-default: true
                  value:
                    id: '500123'
                    status: PENDING
                    traceIds:
                      AVAILITY_TRACE_ID: a1b2c3d4e5f6a1b2c3d4e5f6a1b2c3d4
                      PAYER_TRACE_ID: 277-trace-001
        '400':
          $ref: '#/components/responses/BadRequest'
        '401':
          $ref: '#/components/responses/Unauthorized'
    get:
      operationId: listClaimStatusInquiries
      summary: Availity List Claim Status Inquiries
      description: Retrieve a list of previous claim status inquiries for the authenticated provider.
      tags:
      - Claim Status
      x-microcks-operation:
        delay: 0
        dispatcher: FALLBACK
      parameters:
      - name: fromDate
        in: query
        schema:
          type: string
          format: date
        description: Start date filter (ISO 8601)
        example: '2025-01-01'
      - name: toDate
        in: query
        schema:
          type: string
          format: date
        description: End date filter (ISO 8601)
        example: '2025-12-31'
      - name: payerId
        in: query
        schema:
          type: string
        description: Filter by payer ID
        example: BCBS001
      - name: limit
        in: query
        schema:
          type: integer
          default: 25
          minimum: 1
          maximum: 50
        description: Number of results per page
      - name: offset
        in: query
        schema:
          type: integer
          default: 0
        description: Pagination offset
      responses:
        '200':
          description: List of claim status inquiries
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/ClaimStatusList'
components:
  responses:
    Unauthorized:
      description: Unauthorized
      content:
        application/json:
          schema:
            $ref: '#/components/schemas/Error'
    BadRequest:
      description: Bad request
      content:
        application/json:
          schema:
            $ref: '#/components/schemas/Error'
  schemas:
    ClaimStatusResponse:
      type: object
      properties:
        id:
          type: string
          description: Availity transaction ID
          example: '500123'
        status:
          type: string
          enum:
          - ACKNOWLEDGED
          - ACTION_REQUIRED
          - ADJUSTED
          - CAPITATED
          - DENIED
          - ERROR
          - FINALIZED
          - PAID
          - PENDING
          - REJECTED
          - RETURNED_TO_PROVIDER
          example: PAID
        traceIds:
          type: object
          properties:
            AVAILITY_TRACE_ID:
              type: string
              example: a1b2c3d4e5f6a1b2c3d4e5f6a1b2c3d4
            PAYER_TRACE_ID:
              type: string
              example: 277-trace-001
        amounts:
          type: object
          properties:
            billed:
              type: number
              example: 250.0
            allowed:
              type: number
              example: 200.0
            paid:
              type: number
              example: 160.0
            patientResponsibility:
              type: number
              example: 40.0
        completeCode:
          type: string
          example: COMPLETE
        errors:
          type: array
          items:
            type: object
            properties:
              code:
                type: string
              message:
                type: string
    Error:
      type: object
      properties:
        code:
          type: string
          example: INVALID_REQUEST
        message:
          type: string
          example: 'Required field missing: payerId'
        details:
          type: array
          items:
            type: string
    ClaimStatusList:
      type: object
      properties:
        data:
          type: array
          items:
            $ref: '#/components/schemas/ClaimStatusResponse'
        total:
          type: integer
          example: 42
        offset:
          type: integer
          example: 0
    ClaimStatusRequest:
      type: object
      required:
      - payerId
      - provider
      - subscriber
      properties:
        payerId:
          type: string
          description: Availity payer ID
          example: BCBS001
        provider:
          type: object
          properties:
            npi:
              type: string
              description: National Provider Identifier
              example: '1234567890'
            taxId:
              type: string
              example: '123456789'
        subscriber:
          type: object
          properties:
            memberId:
              type: string
              example: MEM123456
            firstName:
              type: string
              example: Jane
            lastName:
              type: string
              example: Smith
            dateOfBirth:
              type: string
              format: date
              example: '1980-01-15'
        claimNumber:
          type: string
          description: Payer claim number
          example: CLM-2025-001234
        fromDate:
          type: string
          format: date
          example: '2025-01-01'
        toDate:
          type: string
          format: date
          example: '2025-12-31'
  securitySchemes:
    oauth2:
      type: oauth2
      flows:
        clientCredentials:
          tokenUrl: https://api.availity.com/availity/v1/token
          scopes:
            hipaa: Access to HIPAA transaction APIs