availity Enhanced Claim Status API

openapi: 3.1.0
info:
  title: Availity Claim Attachments Auth Attachments Enhanced 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: Enhanced Claim Status
  description: Enhanced claim status with value-add data
paths:
  /clmsmgmt/claim-status/claim-status/v1/status/searchBy276:
    post:
      operationId: searchClaimBy276
      summary: Availity Search Claim by X12 276
      description: Convert a standard ASC X12N 276 claim status request into JSON format and submit to payer.
      tags:
      - Enhanced Claim Status
      x-microcks-operation:
        delay: 0
        dispatcher: FALLBACK
      requestBody:
        required: true
        content:
          application/json:
            schema:
              $ref: '#/components/schemas/SearchBy276Request'
      responses:
        '200':
          description: 276 search initiated
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/AsyncJobResponse'
        '400':
          $ref: '#/components/responses/BadRequest'
    get:
      operationId: pollSearchBy276
      summary: Availity Poll X12 276 Search Results
      description: Poll for results of a previously submitted 276 claim status request.
      tags:
      - Enhanced Claim Status
      x-microcks-operation:
        delay: 0
        dispatcher: FALLBACK
      parameters:
      - name: id
        in: query
        required: true
        schema:
          type: string
        description: Job ID returned from POST
        example: '500123'
      responses:
        '200':
          description: 276 search results
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/ClaimStatusResponse'
        '404':
          $ref: '#/components/responses/NotFound'
  /clmsmgmt/claim-status/claim-status/v1/status/summarySearch:
    post:
      operationId: summarySearchClaims
      summary: Availity Summary Search Claims
      description: High-level claim searches using service dates, member IDs, or check numbers.
      tags:
      - Enhanced Claim Status
      x-microcks-operation:
        delay: 0
        dispatcher: FALLBACK
      requestBody:
        required: true
        content:
          application/json:
            schema:
              $ref: '#/components/schemas/SummarySearchRequest'
      responses:
        '200':
          description: Summary search results
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/ClaimStatusList'
        '400':
          $ref: '#/components/responses/BadRequest'
  /clmsmgmt/claim-status/claim-status/v1/status/detailSearch:
    post:
      operationId: detailSearchClaim
      summary: Availity Detail Search Claim
      description: Detailed single-claim lookup by NPI/tax ID and claim number.
      tags:
      - Enhanced Claim Status
      x-microcks-operation:
        delay: 0
        dispatcher: FALLBACK
      requestBody:
        required: true
        content:
          application/json:
            schema:
              $ref: '#/components/schemas/DetailSearchRequest'
      responses:
        '200':
          description: Claim detail results
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/ClaimStatusResponse'
        '400':
          $ref: '#/components/responses/BadRequest'
components:
  schemas:
    SummarySearchRequest:
      type: object
      required:
      - payerId
      - requestType
      properties:
        payerId:
          type: string
          example: BCBS001
        requestType:
          type: string
          enum:
          - SERVICE_DATE
          - MEMBER_ID
          example: SERVICE_DATE
        memberId:
          type: string
          example: MEM123456
        fromDate:
          type: string
          format: date
          example: '2025-01-01'
        toDate:
          type: string
          format: date
          example: '2025-12-31'
        providerNpi:
          type: string
          example: '1234567890'
        checkNumber:
          type: string
          example: CHK-001234
        requestedStatus:
          type: string
          example: PAID
    ClaimStatusList:
      type: object
      properties:
        data:
          type: array
          items:
            $ref: '#/components/schemas/ClaimStatusResponse'
        total:
          type: integer
          example: 42
        offset:
          type: integer
          example: 0
    DetailSearchRequest:
      type: object
      required:
      - payerId
      - claimNumber
      - requestType
      properties:
        payerId:
          type: string
          example: BCBS001
        claimNumber:
          type: string
          example: CLM-2025-001234
        requestType:
          type: string
          enum:
          - CLAIM_NUMBER
          example: CLAIM_NUMBER
        providerTaxId:
          type: string
          example: '123456789'
        providerNpi:
          type: string
          example: '1234567890'
        processedDate:
          type: string
          format: date
          example: '2025-03-15'
    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
    SearchBy276Request:
      type: object
      required:
      - payerId
      - patientLastName
      - patientFirstName
      - patientBirthDate
      - fromDate
      - toDate
      - providerLastName
      properties:
        payerId:
          type: string
          example: BCBS001
        patientLastName:
          type: string
          example: Smith
        patientFirstName:
          type: string
          example: Jane
        patientBirthDate:
          type: string
          format: date
          example: '1980-01-15'
        fromDate:
          type: string
          format: date
          example: '2025-01-01'
        toDate:
          type: string
          format: date
          example: '2025-12-31'
        providerLastName:
          type: string
          example: Johnson
        patientSameAsSubscriber:
          type: boolean
          example: true
    AsyncJobResponse:
      type: object
      properties:
        id:
          type: string
          description: Job ID for polling
          example: '500123'
        status:
          type: string
          example: PROCESSING
  responses:
    NotFound:
      description: Not found
      content:
        application/json:
          schema:
            $ref: '#/components/schemas/Error'
    BadRequest:
      description: Bad request
      content:
        application/json:
          schema:
            $ref: '#/components/schemas/Error'
  securitySchemes:
    oauth2:
      type: oauth2
      flows:
        clientCredentials:
          tokenUrl: https://api.availity.com/availity/v1/token
          scopes:
            hipaa: Access to HIPAA transaction APIs