Availity Eligibility and Benefits (X12 270/271)

arazzo: 1.0.1
info:
  title: Availity Eligibility and Benefits (X12 270/271)
  summary: Locate a payer that supports the 270 transaction, submit an X12 270 eligibility request, then retrieve the resulting 271 benefit response.
  description: >-
    The canonical Availity eligibility flow, modeled on the X12 270/271 health
    care eligibility/benefit inquiry and response transaction set. A payer that
    supports the 270 transaction is located, an eligibility inquiry is submitted
    for the member, and the completed 271 benefit response is read back by its
    Availity transaction id. Every step inlines its request so the flow is
    self-contained.
  version: 1.0.0
sourceDescriptions:
- name: availityEligibility
  url: ../openapi/availity-eligibility-openapi.yml
  type: openapi
workflows:
- workflowId: eligibility-benefits
  summary: Find a 270-capable payer, submit the eligibility inquiry, and read the 271 benefit response.
  description: >-
    Implements the X12 270/271 eligibility/benefit sequence end to end: payer
    lookup, 270 inquiry submission, and retrieval of the 271 benefit response.
  inputs:
    type: object
    required:
    - eligibilityRequest
    properties:
      eligibilityRequest:
        type: object
        description: The X12 270 eligibility inquiry packet (payer, provider, subscriber, and requested service types).
  steps:
  - stepId: findPayer
    description: Locate a payer in the Availity directory that supports the X12 270 eligibility transaction.
    operationId: listPayers
    parameters:
    - name: supportedTransaction
      in: query
      value: "270"
    successCriteria:
    - condition: $statusCode == 200
    outputs:
      payers: $response.body
  - stepId: checkEligibility
    description: Submit the X12 270 eligibility inquiry for the member to the selected payer.
    operationId: checkEligibility
    requestBody:
      contentType: application/json
      payload: $inputs.eligibilityRequest
    successCriteria:
    - condition: $statusCode == 200
    outputs:
      eligibilityId: $response.body#/id
  - stepId: getEligibility
    description: Retrieve the completed X12 271 benefit response by its Availity transaction id.
    operationId: getEligibility
    parameters:
    - name: id
      in: path
      value: $steps.checkEligibility.outputs.eligibilityId
    successCriteria:
    - condition: $statusCode == 200
    outputs:
      benefits: $response.body
  outputs:
    eligibilityId: $steps.checkEligibility.outputs.eligibilityId
    benefits: $steps.getEligibility.outputs.benefits