Availity

availity Service Reviews API

Prior authorization and service review requests

GitHub OpenAPI

Operations 3

POST /availity/intelligent-payer-network/v1/service-reviews Availity Create Service Review #
GET /availity/intelligent-payer-network/v1/service-reviews Availity List Service Reviews #
GET /availity/intelligent-payer-network/v1/service-reviews/{id} Availity Get Service Review #

Documentation

📖
Documentation
https://developer.availity.com/blog
📖
GettingStarted
https://developer.availity.com/partner/gettingstarted
📖
Documentation
https://developer.availity.com/blog/2025/3/4/ebvalue-add-api
📖
Documentation
https://developer.availity.com/blog/2025/3/25/enhanced-claim-status
📖
Documentation
https://developer.availity.com/blog/2025/2/28/claim-attachment-api
📖
Documentation
https://developer.availity.com/blog/2025/3/4/service-reviews

Specifications

⚙
OpenAPI
https://raw.githubusercontent.com/api-evangelist/availity/refs/heads/main/openapi/availity-service-reviews-api-openapi.yml

Schemas & Data

📊
JSONSchema
https://raw.githubusercontent.com/api-evangelist/availity/refs/heads/main/json-schema/availity-eligibility-schema.json

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OpenAPI Specification

availity-service-reviews-api-openapi.yml Raw ↑ 
openapi: 3.2.0
info:
  title: Availity Claim Attachments Auth Attachments Service Reviews 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: Service Reviews
  description: Prior authorization and service review requests
paths:
  /availity/intelligent-payer-network/v1/service-reviews:
    post:
      operationId: createServiceReview
      summary: Availity Create Service Review
      description: Submit a prior authorization or service review request (X12 278 transaction) to a health plan payer.
      tags:
      - Service Reviews
      x-microcks-operation:
        delay: 0
        dispatcher: FALLBACK
      requestBody:
        required: true
        content:
          application/json:
            schema:
              $ref: '#/components/schemas/ServiceReviewRequest'
      responses:
        '200':
          description: Service review created
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/ServiceReviewResponse'
              examples:
                CreateServiceReview200Example:
                  summary: Default createServiceReview 200 response
                  x-microcks-default: true
                  value:
                    id: '500123'
                    status: PENDING
                    certificationNumber: AUTH-2025-001234
        '400':
          $ref: '#/components/responses/BadRequest'
        '401':
          $ref: '#/components/responses/Unauthorized'
    get:
      operationId: listServiceReviews
      summary: Availity List Service Reviews
      description: Retrieve a list of previous service review submissions for the authenticated provider.
      tags:
      - Service Reviews
      x-microcks-operation:
        delay: 0
        dispatcher: FALLBACK
      parameters:
      - 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 service reviews
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/ServiceReviewList'
  /availity/intelligent-payer-network/v1/service-reviews/{id}:
    get:
      operationId: getServiceReview
      summary: Availity Get Service Review
      description: Retrieve the status and details of a specific service review by ID.
      tags:
      - Service Reviews
      x-microcks-operation:
        delay: 0
        dispatcher: FALLBACK
      parameters:
      - name: id
        in: path
        required: true
        schema:
          type: string
        description: Service review transaction ID
        example: '500123'
      responses:
        '200':
          description: Service review details
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/ServiceReviewResponse'
        '404':
          $ref: '#/components/responses/NotFound'
components:
  schemas:
    ServiceReviewList:
      type: object
      properties:
        data:
          type: array
          items:
            $ref: '#/components/schemas/ServiceReviewResponse'
        total:
          type: integer
          example: 15
        offset:
          type: integer
          example: 0
    ServiceReviewRequest:
      type: object
      required:
      - payerId
      - provider
      - subscriber
      - requestType
      properties:
        payerId:
          type: string
          example: BCBS001
        requestType:
          type: string
          enum:
          - INITIAL
          - UPDATE
          - CANCEL
          - REFERRAL
          example: INITIAL
        provider:
          type: object
          properties:
            npi:
              type: string
              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
        serviceInformation:
          type: object
          properties:
            procedureCodes:
              type: array
              items:
                type: string
            diagnosisCodes:
              type: array
              items:
                type: string
            serviceFromDate:
              type: string
              format: date
            serviceToDate:
              type: string
              format: date
    Error:
      type: object
      properties:
        code:
          type: string
          example: INVALID_REQUEST
        message:
          type: string
          example: Required field missing
        details:
          type: array
          items:
            type: string
    ServiceReviewResponse:
      type: object
      properties:
        id:
          type: string
          example: '500123'
        status:
          type: string
          enum:
          - PENDING
          - APPROVED
          - DENIED
          - PARTIALLY_APPROVED
          - PENDING_ADDITIONAL_INFO
          example: APPROVED
        certificationNumber:
          type: string
          example: AUTH-2025-001234
        effectiveDate:
          type: string
          format: date
          example: '2025-04-01'
        expirationDate:
          type: string
          format: date
          example: '2025-10-01'
  responses:
    Unauthorized:
      description: Unauthorized
      content:
        application/json:
          schema:
            $ref: '#/components/schemas/Error'
    BadRequest:
      description: Bad request
      content:
        application/json:
          schema:
            $ref: '#/components/schemas/Error'
    NotFound:
      description: Not found
      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