Availity

Availity is a healthcare information network and clearinghouse providing REST APIs for real-time HIPAA EDI transactions. The platform processes over 11 billion annual healthcare transactions connecting providers, health plans, and vendors nationwide. Create your application and subscribe to a plan to make use of Availity APIs for eligibility verification, claims management, prior authorization, and patient cost estimation.

Availity publishes 7 APIs on the APIs.io network, including Auth Attachments API, Claim Attachments API, Claim Status API, and 4 more. Tagged areas include Healthcare, Clearinghouse, HIPAA, X12 EDI, and Eligibility.

The Availity catalog on APIs.io includes 5 JSON-LD contexts and 2 Spectral governance rulesets.

Availity’s developer surface includes developer portal, documentation, getting-started guide, support, authentication, API reference, engineering blog, and 57 more developer resources.

🌐 Visit website 📡 Source on GitHub

76.2/100 exemplar ▬ flat Agent 40/100 agent ready Full breakdown ↓
scored 2026-08-20 · rubric v0.12.0

AccessPaidSelf serve

12 APIs 8 Features 8 Use Cases

HealthcareClearinghouseHIPAAX12 EDIEligibilityClaimsPrior AuthorizationRevenue Cycle ManagementPayersPrice Transparency

Kin Score

Kin Score How this is scored →
scored 2026-08-20 · rubric v0.12.0

Composite quality — 76.2/100 · exemplar

Contract Quality 15.5 / 21

Developer Ergonomics 13.3 / 17

Access Clarity 12.5 / 17

Operational Transparency 5.8 / 11

Contract Governance 5.6 / 10

Discoverability 6.9 / 9

Regulatory Posture 8.8 / 15

Agent readiness — 40/100 · agent ready

Machine-Readable Contract 18 / 18

Agentic Access Contract 10 / 10

Documented Reversibility 0 / 6

MCP Server 0 / 12

Machine-Readable Auth 10 / 10

Idempotency 0 / 9

Stable Error Semantics 8 / 8

Request/Response Examples 7 / 7

Rate-Limit Signaling 7 / 7

Typed Event Surface 0 / 6

Agent Skills 5 / 5

Well-Known Catalog 0 / 4

Consent & Bot Identity 0 / 3

A2A Agent Card 0 / 8

Dry-Run / Simulate Mode 0 / 4

Regulatory Posture applies to this provider. Its tags matched the Health regime, so Regulatory Posture carries 15 points of the composite. If this regime is wrong for your business, say so on your provider repo — the applicability map is public and we will correct it.

The six quality facets above are damped to 85 points between them, because the conditional facet above carries the other 15. That is why each facet's contribution is shown against a damped maximum: raising a quality facet moves the composite by 85% of its nominal weight, not 100%. The full arithmetic is at apis.io/rating/.

Improve this rating by publishing the missing artifacts — every area above can be raised, and the full rubric is at apis.io/rating/. This rating is computed from github.com/api-evangelist/availity: open an issue to ask a question, or submit a pull request to add artifacts. Want it done for you? Prioritized profiling — $2,500 →

APIs 12

Individual APIs this provider publishes, each with its own machine-readable definition.

Availity Healthcare HIPAA Transactions API

The Availity Healthcare HIPAA Transactions API provides a unified interface for standard HIPAA EDI transactions. REST APIs enable healthcare providers and vendors to submit and ...

Availity Patient Cost Estimator API

The Availity Patient Cost Estimator API enables healthcare providers and institutions to estimate service costs before delivery for both institutional and professional services....

Availity Eligibility & Benefits Value-Add APIs

The Availity Eligibility & Benefits Value-Add APIs provide supplementary data during eligibility transactions. The Care Reminders API retrieves real-time care gap information fr...

Availity Payer List API

The Availity Payer List API (v1.0.4) allows healthcare organizations to query available payers and the transactions they support. Returns payer identifiers, names, and supported...

Availity Configurations API

The Availity Configurations API (v1.0.0) provides provider details and payer-specific validation requirements. Returns configuration rules for enhanced claim status, prior autho...

availity Auth Attachments API

Attach documentation to authorization requests

availity Claim Attachments API

Electronic claim attachment submission and retrieval

availity Claim Status API

Claim status inquiries and tracking

availity Eligibility API

Real-time eligibility and benefits verification

availity Enhanced Claim Status API

Enhanced claim status with value-add data

availity Is Auth Required API

Check if authorization is required before submission

availity Service Reviews API

Prior authorization and service review requests

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Open Collections 10

Open, tool-agnostic API collections (OpenAPI-derived and Bruno).

API Collection

OPEN COLLECTION

Availity Claim Attachments Auth Attachments API

OPEN COLLECTION

Availity Auth Attachments Claim Attachments API

OPEN COLLECTION

Availity Claim Attachments API

OPEN COLLECTION

Availity Claim Attachments Auth Attachments Claim Status API

OPEN COLLECTION

Availity Claim Status API

OPEN COLLECTION

Availity Claim Attachments Auth Attachments Eligibility API

OPEN COLLECTION

Availity Eligibility & Benefits API

OPEN COLLECTION

Availity Claim Attachments Auth Attachments Enhanced Claim Status API

OPEN COLLECTION

Availity Claim Attachments Auth Attachments Is Auth Required API

OPEN COLLECTION

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Arazzo Workflows 4

Multi-step API workflows described with the Arazzo specification.

Availity Claim Attachment (X12 275)

Submit an X12 275 claim attachment, then poll for its processing status until the payer accepts it.

ARAZZO

Availity Claim Status Inquiry (X12 276/277)

Submit an X12 276 claim status request, then poll for the X12 277 claim status response until the payer finalizes it.

ARAZZO

Availity Eligibility and Benefits (X12 270/271)

Locate a payer that supports the 270 transaction, submit an X12 270 eligibility request, then retrieve the resulting 271 benefit response.

ARAZZO

Availity Prior Authorization (X12 278)

Determine whether authorization is required, create the X12 278 service review, attach supporting clinical documentation, then read back the authorization decision.

ARAZZO

Pricing Plans 1

Published pricing tiers and plan structures.

Availity Plans Pricing

7 plans

PLANS

Rate Limits 1

Documented rate limits and quota policies.

Availity Rate Limits

4 limits

RATE LIMITS

FinOps 1

Cost, billing, and metering signals for API financial operations.

Availity Finops

FINOPS

Features 8

Notable capabilities this provider offers.

OAuth 2.0 Authentication

Client credentials grant flow with 5-minute token expiration and HTTPS/TLS encryption for secure API access.

Real-Time EDI Transactions

Processing over 8.8 million daily transactions and 11 billion annual healthcare transactions across all major health plans.

Nationwide Payer Network

Access to every major health plan nationwide and over 1 million providers through the Availity clearinghouse.

Multi-Format Responses

Returns JSON and XML representations including errors using HTTP response codes. Supports CSV, PDF, PNG, and XLS for specific endpoints.

Cursor-Based Pagination

Collection resources support offset/limit pagination with limit range of 1-50 items per request with link relations.

Mock/Sandbox Testing

Demo subscriptions support custom response selection via X-Api-Mock-Scenario-ID and X-Api-Mock-Response headers.

Rate Limiting

Standard tier provides 100,000 calls per day and 100 calls per second for HIPAA transaction APIs.

ASC X12 EDI Standards

Full support for HIPAA EDI version 005010 transactions including 270/271, 276/277, 278, and 835 transaction sets.

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Semantic Vocabularies 5

JSON-LD contexts and semantic vocabularies used across these APIs.

Availity Availity Context

2 classes · 32 properties

JSON-LD

Availity Claim Context

9 classes · 45 properties

JSON-LD

Availity Context

0 classes · 5 properties

JSON-LD

Availity Eligibility Context

15 classes · 58 properties

JSON-LD

Availity Service Context

8 classes · 30 properties

JSON-LD

Spectral Rules 2

Spectral governance rulesets for linting and validating these APIs.

Availity API Rules

6 rules · 4 warnings 2 info

SPECTRAL

Availity API Rules

10 rules · 1 errors 7 warnings 2 info

SPECTRAL

JSON Schema 63

Standalone JSON Schema definitions for this provider's data models.

AsyncJobResponse

2 properties

JSON SCHEMA

AttachmentRequest

6 properties

JSON SCHEMA

AttachmentStatusResponse

2 properties

JSON SCHEMA

Benefit

7 properties

JSON SCHEMA

ClaimAttachmentRequest

5 properties

JSON SCHEMA

ClaimAttachmentResponse

3 properties

JSON SCHEMA

ClaimStatusList

3 properties

JSON SCHEMA

ClaimStatusRequest

6 properties

JSON SCHEMA

ClaimStatusResponse

6 properties

JSON SCHEMA

Coverage

8 properties

JSON SCHEMA

Dependent

5 properties

JSON SCHEMA

DetailSearchRequest

6 properties

JSON SCHEMA

Availity Eligibility Response

8 properties

JSON SCHEMA

EligibilityError

4 properties

JSON SCHEMA

EligibilityList

3 properties

JSON SCHEMA

EligibilityRequest

6 properties

JSON SCHEMA

EligibilityResponse

8 properties

JSON SCHEMA

Error

3 properties

JSON SCHEMA

IsAuthRequiredRequest

1 properties

JSON SCHEMA

IsAuthRequiredResponse

3 properties

JSON SCHEMA

Payer

2 properties

JSON SCHEMA

PayerInfo

3 properties

JSON SCHEMA

PayerList

1 properties

JSON SCHEMA

PlanInformation

5 properties

JSON SCHEMA

Provider

6 properties

JSON SCHEMA

SearchBy276Request

8 properties

JSON SCHEMA

ServiceReviewList

3 properties

JSON SCHEMA

ServiceReviewRequest

5 properties

JSON SCHEMA

ServiceReviewResponse

5 properties

JSON SCHEMA

Subscriber

7 properties

JSON SCHEMA

SubscriberInfo

7 properties

JSON SCHEMA

SummarySearchRequest

8 properties

JSON SCHEMA

ClaimAttachmentRequest

5 properties

JSON SCHEMA

ClaimAttachmentResponse

3 properties

JSON SCHEMA

AsyncJobResponse

2 properties

JSON SCHEMA

ClaimStatusList

3 properties

JSON SCHEMA

ClaimStatusRequest

6 properties

JSON SCHEMA

ClaimStatusResponse

6 properties

JSON SCHEMA

DetailSearchRequest

6 properties

JSON SCHEMA

SearchBy276Request

8 properties

JSON SCHEMA

SummarySearchRequest

8 properties

JSON SCHEMA

Benefit

7 properties

JSON SCHEMA

Coverage

8 properties

JSON SCHEMA

Dependent

5 properties

JSON SCHEMA

EligibilityError

4 properties

JSON SCHEMA

EligibilityList

3 properties

JSON SCHEMA

EligibilityRequest

6 properties

JSON SCHEMA

EligibilityResponse

8 properties

JSON SCHEMA

PayerInfo

3 properties

JSON SCHEMA

PayerList

1 properties

JSON SCHEMA

Payer

2 properties

JSON SCHEMA

PlanInformation

5 properties

JSON SCHEMA

Provider

6 properties

JSON SCHEMA

SubscriberInfo

7 properties

JSON SCHEMA

Subscriber

7 properties

JSON SCHEMA

AsyncJobResponse

2 properties

JSON SCHEMA

AttachmentRequest

6 properties

JSON SCHEMA

AttachmentStatusResponse

2 properties

JSON SCHEMA

IsAuthRequiredRequest

1 properties

JSON SCHEMA

IsAuthRequiredResponse

3 properties

JSON SCHEMA

ServiceReviewList

3 properties

JSON SCHEMA

ServiceReviewRequest

5 properties

JSON SCHEMA

ServiceReviewResponse

5 properties

JSON SCHEMA

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JSON Structure 33

JSON Structure definitions describing this provider's data shapes.

Availity Eligibility Structure

8 properties

JSON STRUCTURE

Availity Structure

0 properties

JSON STRUCTURE

Claim Attachments Claim Attachment Request Structure

5 properties

JSON STRUCTURE

Claim Attachments Claim Attachment Response Structure

3 properties

JSON STRUCTURE

Claim Status Async Job Response Structure

2 properties

JSON STRUCTURE

Claim Status Claim Status List Structure

3 properties

JSON STRUCTURE

Claim Status Claim Status Request Structure

6 properties

JSON STRUCTURE

Claim Status Claim Status Response Structure

6 properties

JSON STRUCTURE

Claim Status Detail Search Request Structure

6 properties

JSON STRUCTURE

Claim Status Search By276 Request Structure

8 properties

JSON STRUCTURE

Claim Status Summary Search Request Structure

8 properties

JSON STRUCTURE

Eligibility Benefit Structure

7 properties

JSON STRUCTURE

Eligibility Coverage Structure

8 properties

JSON STRUCTURE

Eligibility Dependent Structure

5 properties

JSON STRUCTURE

Eligibility Eligibility Error Structure

4 properties

JSON STRUCTURE

Eligibility Eligibility List Structure

3 properties

JSON STRUCTURE

Eligibility Eligibility Request Structure

6 properties

JSON STRUCTURE

Eligibility Eligibility Response Structure

8 properties

JSON STRUCTURE

Eligibility Payer Info Structure

3 properties

JSON STRUCTURE

Eligibility Payer List Structure

1 properties

JSON STRUCTURE

Eligibility Payer Structure

2 properties

JSON STRUCTURE

Eligibility Plan Information Structure

5 properties

JSON STRUCTURE

Eligibility Provider Structure

6 properties

JSON STRUCTURE

Eligibility Subscriber Info Structure

7 properties

JSON STRUCTURE

Eligibility Subscriber Structure

7 properties

JSON STRUCTURE

Service Reviews Async Job Response Structure

2 properties

JSON STRUCTURE

Service Reviews Attachment Request Structure

6 properties

JSON STRUCTURE

Service Reviews Attachment Status Response Structure

2 properties

JSON STRUCTURE

Service Reviews Is Auth Required Request Structure

1 properties

JSON STRUCTURE

Service Reviews Is Auth Required Response Structure

3 properties

JSON STRUCTURE

Service Reviews Service Review List Structure

3 properties

JSON STRUCTURE

Service Reviews Service Review Request Structure

5 properties

JSON STRUCTURE

Service Reviews Service Review Response Structure

5 properties

JSON STRUCTURE

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Examples 35

Example request and response payloads for these APIs.

Availity Createclaimstatusinquiry Example

6 fields

EXAMPLE

Availity Createservicereview Example

6 fields

EXAMPLE

Availity Eligibility Example

5 fields

EXAMPLE

Availity Submitclaimattachment Example

6 fields

EXAMPLE

Claim Attachments Claim Attachment Request Example

5 fields

EXAMPLE

Claim Attachments Claim Attachment Response Example

3 fields

EXAMPLE

Claim Status Async Job Response Example

2 fields

EXAMPLE

Claim Status Claim Status List Example

3 fields

EXAMPLE

Claim Status Claim Status Request Example

6 fields

EXAMPLE

Claim Status Claim Status Response Example

6 fields

EXAMPLE

Claim Status Detail Search Request Example

6 fields

EXAMPLE

Claim Status Search By276 Request Example

8 fields

EXAMPLE

Claim Status Summary Search Request Example

8 fields

EXAMPLE

Eligibility Benefit Example

7 fields

EXAMPLE

Eligibility Coverage Example

8 fields

EXAMPLE

Eligibility Dependent Example

5 fields

EXAMPLE

Eligibility Eligibility Error Example

4 fields

EXAMPLE

Eligibility Eligibility List Example

3 fields

EXAMPLE

Eligibility Eligibility Request Example

2 fields

EXAMPLE

Eligibility Eligibility Response Example

5 fields

EXAMPLE

Eligibility Payer Example

2 fields

EXAMPLE

Eligibility Payer Info Example

3 fields

EXAMPLE

Eligibility Payer List Example

1 fields

EXAMPLE

Eligibility Plan Information Example

5 fields

EXAMPLE

Eligibility Provider Example

6 fields

EXAMPLE

Eligibility Subscriber Example

7 fields

EXAMPLE

Eligibility Subscriber Info Example

7 fields

EXAMPLE

Service Reviews Async Job Response Example

2 fields

EXAMPLE

Service Reviews Attachment Request Example

6 fields

EXAMPLE

Service Reviews Attachment Status Response Example

2 fields

EXAMPLE

Service Reviews Is Auth Required Request Example

1 fields

EXAMPLE

Service Reviews Is Auth Required Response Example

3 fields

EXAMPLE

Service Reviews Service Review List Example

3 fields

EXAMPLE

Service Reviews Service Review Request Example

5 fields

EXAMPLE

Service Reviews Service Review Response Example

5 fields

EXAMPLE

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Security Posture 2

Authentication, domain security, vulnerability disclosure, and trust-center signals.

Availity Authentication

oauth2 · 1 scheme

SECURITY

Availity Domain Security

TLSv1.3 · DMARC

SECURITY

Scopes 1

OAuth scopes governing access to this provider's APIs.

Availity Scopes

10 scopes

SCOPES

Agentic Access 1

Recommended x-agentic-access execution contracts for AI agents.

Availity Agentic Access

19 operations · 9 acting

AGENTIC

Use Cases 8

What developers build with this provider.

Real-Time Eligibility Verification

Verify patient insurance coverage, co-pays, deductibles, and benefits in real time before scheduling or rendering services.

Claim Status Tracking

Track submitted claims through adjudication, checking ACKNOWLEDGED, PENDING, PAID, DENIED, and ADJUSTED statuses.

Prior Authorization Management

Submit and track prior authorization requests using X12 278 transactions to check if authorization is required before service delivery.

Patient Cost Estimation

Estimate patient out-of-pocket costs before services are rendered to meet price transparency requirements and inform patients.

Electronic Claim Attachments

Electronically attach clinical documentation to claims and authorizations, reducing manual faxing and accelerating adjudication.

Care Gap Identification

Retrieve real-time care reminders during eligibility checks to identify preventive care gaps and coordinate outreach.

Digital Member ID Cards

Retrieve member ID cards digitally during eligibility verification, reducing administrative burden and improving patient experience.

Multi-Payer Data Consolidation

Connect to all major payers through a single clearinghouse API rather than managing individual payer connections.

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Integrations 8

Pre-built integrations with other platforms and tools.

EHR Systems

Integrates with electronic health record systems to embed eligibility and claims workflows into clinical workflows.

Practice Management Systems

Connects practice management software to payer networks for revenue cycle management and claims processing.

Revenue Cycle Management Platforms

Integrates with RCM platforms to automate eligibility verification, claim submission, and payment reconciliation.

Blue Cross Blue Shield Plans

Direct integration with BCBS plans nationwide for eligibility, claims, and prior authorization transactions.

Humana

Integration with Humana for care reminders, eligibility verification, and claims processing.

Molina Healthcare

Integration with Molina Healthcare for eligibility and benefits verification and care reminders.

Florida Blue

Integration with Florida Blue for care reminders and real-time eligibility verification.

Healthfirst New York

Integration with Healthfirst New York for eligibility and care gap identification.

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Resources

Get Started 5

Portal, sign-up, and the first successful call

Portal

GettingStarted

DeveloperPortal

SignUp

Sandbox

Documentation 15

Reference material describing how the API behaves

Documentation

Documentation

JSONSchema

APIReference

OpenAPI

OpenAPI

OpenAPI

OpenAPI

OpenAPI

OpenAPI

OpenAPI

OpenAPI

OpenAPI

OpenAPI

OpenAPI

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Agent Surfaces 3

MCP servers, agent skills, and machine-readable catalogs

AgenticAccess

AgenticAccess

AgentSkill

AgentSkill

LLMsTxt

LLMsTxt

Design & Contract 12

Pagination, idempotency, versioning, errors, and events

JSONLD

JSONLD

JSONLD

SpectralRules

Vocabulary

Components

Conventions

ErrorCatalog

Lifecycle

Conformance

DataModel

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Build 5

SDKs, sample code, and the tooling you integrate with

GitHubOrganization

SDKs

Packages

SDKs

CLI

Access & Security 4

Authentication, authorization, and security posture

DomainSecurity

Authentication

OAuthScopes

Compliance

Operate 3

Status, limits, changes, and where to get help

Support

Support

StatusPage

StatusPage

RateLimits

RateLimits

Commercial 4

Pricing, plans, and the legal terms of use

TermsOfService

PrivacyPolicy

Plans

FinOps

Company 3

The organization behind the API

LinkedIn

Website

Website

Blog

Blog

Other 11

Properties that don't map to a standard resource type

Overlay

Overlay

Overlay

Overlay

Overlay

Overlay

Overlay

Overlay

Overlay

Overlay

Overlay

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Source (apis.yml)

aid: availity
name: Availity
created: '2026-04-20'
specificationVersion: '0.23'
tags:
- Healthcare
- Clearinghouse
- HIPAA
- X12 EDI
- Eligibility
- Claims
- Prior Authorization
- Revenue Cycle Management
- Payers
- Price Transparency
accessModel:
  pricing: paid
  onboarding: self-serve
  trial: false
  try_now: false
  public: false
  label: Paid · Self-serve signup
  confidence: high
  source:
  - plans
  - authentication
  generated: '2026-07-22'
  method: derived
image: https://kinlane-images.s3.amazonaws.com/shared/apis-json/icons/availity.png
url: https://raw.githubusercontent.com/api-evangelist/availity/refs/heads/main/apis.yml
apis:
- aid: availity:availity-hipaa-transactions-api
  name: Availity Healthcare HIPAA Transactions API
  tags:
  - Clearinghouse
  - EDI
  - Healthcare
  - HIPAA
  image: https://raw.githubusercontent.com/api-evangelist/availity/refs/heads/main/image.png
  humanURL: https://developer.availity.com/portal/catalogue-products/healthcare-hipaa-transactions-1
  baseURL: https://api.availity.com
  properties:
  - url: https://developer.availity.com/portal/catalogue-products/healthcare-hipaa-transactions-1
    type: Documentation
  - url: https://developer.availity.com/blog/2025/3/25/hipaa-transactions
    type: Documentation
  - url: https://developer.availity.com/partner/gettingstarted
    type: GettingStarted
  description: 'The Availity Healthcare HIPAA Transactions API provides a unified interface for standard HIPAA EDI transactions.
    REST APIs enable healthcare providers and vendors to submit and receive X12 EDI transactions across payers including eligibility,
    claims, remittance, authorizations, and referrals. Quota: 100,000 calls per day, 100 calls per second rate limit.'
- aid: availity:availity-patient-cost-estimator-api
  name: Availity Patient Cost Estimator API
  tags:
  - Cost Estimation
  - Healthcare
  - Patient Financial Responsibility
  - Price Transparency
  image: https://raw.githubusercontent.com/api-evangelist/availity/refs/heads/main/image.png
  humanURL: https://developer.availity.com/
  baseURL: https://api.availity.com
  properties:
  - url: https://developer.availity.com/blog
    type: Documentation
  - url: https://developer.availity.com/partner/gettingstarted
    type: GettingStarted
  description: The Availity Patient Cost Estimator API enables healthcare providers and institutions to estimate service costs
    before delivery for both institutional and professional services. REST APIs support version 1.0.0 and 2.0.0 and include
    predetermination requests across all major health plan payers, helping meet price transparency requirements.
- aid: availity:availity-eb-value-adds-api
  name: Availity Eligibility & Benefits Value-Add APIs
  tags:
  - Care Reminders
  - EDI
  - Eligibility
  - Healthcare
  - Member ID Card
  image: https://raw.githubusercontent.com/api-evangelist/availity/refs/heads/main/image.png
  humanURL: https://developer.availity.com/
  baseURL: https://api.availity.com
  properties:
  - url: https://developer.availity.com/blog/2025/3/4/ebvalue-add-api
    type: Documentation
  - url: https://developer.availity.com/partner/gettingstarted
    type: GettingStarted
  description: The Availity Eligibility & Benefits Value-Add APIs provide supplementary data during eligibility transactions.
    The Care Reminders API retrieves real-time care gap information from multiple payers. The Member ID Card API retrieves
    digital member ID cards in PDF or PNG format during eligibility verification workflows.
- aid: availity:availity-payer-list-api
  name: Availity Payer List API
  tags:
  - Clearinghouse
  - Healthcare
  - Payer Network
  - Reference Data
  image: https://raw.githubusercontent.com/api-evangelist/availity/refs/heads/main/image.png
  humanURL: https://developer.availity.com/
  baseURL: https://api.availity.com
  properties:
  - url: https://developer.availity.com/blog
    type: Documentation
  - url: https://developer.availity.com/partner/gettingstarted
    type: GettingStarted
  description: The Availity Payer List API (v1.0.4) allows healthcare organizations to query available payers and the transactions
    they support. Returns payer identifiers, names, and supported transaction types including eligibility, claim status, prior
    authorization, and remittance across the nationwide Availity clearinghouse network.
- aid: availity:availity-configurations-api
  name: Availity Configurations API
  tags:
  - Configuration
  - Healthcare
  - Payer Requirements
  - Provider Validation
  image: https://raw.githubusercontent.com/api-evangelist/availity/refs/heads/main/image.png
  humanURL: https://developer.availity.com/
  baseURL: https://api.availity.com
  properties:
  - url: https://developer.availity.com/blog
    type: Documentation
  - url: https://developer.availity.com/partner/gettingstarted
    type: GettingStarted
  description: The Availity Configurations API (v1.0.0) provides provider details and payer-specific validation requirements.
    Returns configuration rules for enhanced claim status, prior authorization, and other transaction types so provider systems
    can validate submissions before sending to payers.
- aid: availity:availity-auth-attachments-api
  name: availity Auth Attachments API
  description: Attach documentation to authorization requests
  humanURL: https://developer.availity.com/
  baseURL: https://api.availity.com
  tags:
  - Auth Attachments
  properties:
  - type: OpenAPI
    url: openapi/availity-auth-attachments-api-openapi.yml
  - type: Documentation
    url: https://developer.availity.com/blog
  - type: GettingStarted
    url: https://developer.availity.com/partner/gettingstarted
  - type: Documentation
    url: https://developer.availity.com/blog/2025/3/4/ebvalue-add-api
  - type: JSONSchema
    url: https://raw.githubusercontent.com/api-evangelist/availity/refs/heads/main/json-schema/availity-eligibility-schema.json
  - type: Documentation
    url: https://developer.availity.com/blog/2025/3/25/enhanced-claim-status
  - type: Documentation
    url: https://developer.availity.com/blog/2025/2/28/claim-attachment-api
  - type: Documentation
    url: https://developer.availity.com/blog/2025/3/4/service-reviews
- aid: availity:availity-claim-attachments-api
  name: availity Claim Attachments API
  description: Electronic claim attachment submission and retrieval
  humanURL: https://developer.availity.com/
  baseURL: https://api.availity.com
  tags:
  - Claim Attachments
  properties:
  - type: OpenAPI
    url: openapi/availity-claim-attachments-api-openapi.yml
  - type: Documentation
    url: https://developer.availity.com/blog
  - type: GettingStarted
    url: https://developer.availity.com/partner/gettingstarted
  - type: Documentation
    url: https://developer.availity.com/blog/2025/3/4/ebvalue-add-api
  - type: JSONSchema
    url: https://raw.githubusercontent.com/api-evangelist/availity/refs/heads/main/json-schema/availity-eligibility-schema.json
  - type: Documentation
    url: https://developer.availity.com/blog/2025/3/25/enhanced-claim-status
  - type: Documentation
    url: https://developer.availity.com/blog/2025/2/28/claim-attachment-api
  - type: Documentation
    url: https://developer.availity.com/blog/2025/3/4/service-reviews
- aid: availity:availity-claim-status-api
  name: availity Claim Status API
  description: Claim status inquiries and tracking
  humanURL: https://developer.availity.com/
  baseURL: https://api.availity.com
  tags:
  - Claim Status
  properties:
  - type: OpenAPI
    url: openapi/availity-claim-status-api-openapi.yml
  - type: Documentation
    url: https://developer.availity.com/blog
  - type: GettingStarted
    url: https://developer.availity.com/partner/gettingstarted
  - type: Documentation
    url: https://developer.availity.com/blog/2025/3/4/ebvalue-add-api
  - type: JSONSchema
    url: https://raw.githubusercontent.com/api-evangelist/availity/refs/heads/main/json-schema/availity-eligibility-schema.json
  - type: Documentation
    url: https://developer.availity.com/blog/2025/3/25/enhanced-claim-status
  - type: Documentation
    url: https://developer.availity.com/blog/2025/2/28/claim-attachment-api
  - type: Documentation
    url: https://developer.availity.com/blog/2025/3/4/service-reviews
- aid: availity:availity-eligibility-api
  name: availity Eligibility API
  description: Real-time eligibility and benefits verification
  humanURL: https://developer.availity.com/
  baseURL: https://api.availity.com
  tags:
  - Eligibility
  properties:
  - type: OpenAPI
    url: openapi/availity-eligibility-api-openapi.yml
  - type: Documentation
    url: https://developer.availity.com/blog
  - type: GettingStarted
    url: https://developer.availity.com/partner/gettingstarted
  - type: Documentation
    url: https://developer.availity.com/blog/2025/3/4/ebvalue-add-api
  - type: JSONSchema
    url: https://raw.githubusercontent.com/api-evangelist/availity/refs/heads/main/json-schema/availity-eligibility-schema.json
  - type: Documentation
    url: https://developer.availity.com/blog/2025/3/25/enhanced-claim-status
  - type: Documentation
    url: https://developer.availity.com/blog/2025/2/28/claim-attachment-api
  - type: Documentation
    url: https://developer.availity.com/blog/2025/3/4/service-reviews
- aid: availity:availity-enhanced-claim-status-api
  name: availity Enhanced Claim Status API
  description: Enhanced claim status with value-add data
  humanURL: https://developer.availity.com/
  baseURL: https://api.availity.com
  tags:
  - Enhanced Claim Status
  properties:
  - type: OpenAPI
    url: openapi/availity-enhanced-claim-status-api-openapi.yml
  - type: Documentation
    url: https://developer.availity.com/blog
  - type: GettingStarted
    url: https://developer.availity.com/partner/gettingstarted
  - type: Documentation
    url: https://developer.availity.com/blog/2025/3/4/ebvalue-add-api
  - type: JSONSchema
    url: https://raw.githubusercontent.com/api-evangelist/availity/refs/heads/main/json-schema/availity-eligibility-schema.json
  - type: Documentation
    url: https://developer.availity.com/blog/2025/3/25/enhanced-claim-status
  - type: Documentation
    url: https://developer.availity.com/blog/2025/2/28/claim-attachment-api
  - type: Documentation
    url: https://developer.availity.com/blog/2025/3/4/service-reviews
- aid: availity:availity-is-auth-required-api
  name: availity Is Auth Required API
  description: Check if authorization is required before submission
  humanURL: https://developer.availity.com/
  baseURL: https://api.availity.com
  tags:
  - Is Auth Required
  properties:
  - type: OpenAPI
    url: openapi/availity-is-auth-required-api-openapi.yml
  - type: Documentation
    url: https://developer.availity.com/blog
  - type: GettingStarted
    url: https://developer.availity.com/partner/gettingstarted
  - type: Documentation
    url: https://developer.availity.com/blog/2025/3/4/ebvalue-add-api
  - type: JSONSchema
    url: https://raw.githubusercontent.com/api-evangelist/availity/refs/heads/main/json-schema/availity-eligibility-schema.json
  - type: Documentation
    url: https://developer.availity.com/blog/2025/3/25/enhanced-claim-status
  - type: Documentation
    url: https://developer.availity.com/blog/2025/2/28/claim-attachment-api
  - type: Documentation
    url: https://developer.availity.com/blog/2025/3/4/service-reviews
- aid: availity:availity-service-reviews-api
  name: availity Service Reviews API
  description: Prior authorization and service review requests
  humanURL: https://developer.availity.com/
  baseURL: https://api.availity.com
  tags:
  - Service Reviews
  properties:
  - type: OpenAPI
    url: openapi/availity-service-reviews-api-openapi.yml
  - type: Documentation
    url: https://developer.availity.com/blog
  - type: GettingStarted
    url: https://developer.availity.com/partner/gettingstarted
  - type: Documentation
    url: https://developer.availity.com/blog/2025/3/4/ebvalue-add-api
  - type: JSONSchema
    url: https://raw.githubusercontent.com/api-evangelist/availity/refs/heads/main/json-schema/availity-eligibility-schema.json
  - type: Documentation
    url: https://developer.availity.com/blog/2025/3/25/enhanced-claim-status
  - type: Documentation
    url: https://developer.availity.com/blog/2025/2/28/claim-attachment-api
  - type: Documentation
    url: https://developer.availity.com/blog/2025/3/4/service-reviews
common:
- type: LinkedIn
  url: https://www.linkedin.com/company/availity
- url: https://www.availity.com
  type: Website
- url: https://developer.availity.com/
  type: Portal
- url: https://developer.availity.com/blog
  type: Documentation
- url: https://developer.availity.com/partner/gettingstarted
  type: GettingStarted
- url: https://developer.availity.com/blog/2025/3/25/availity-api-guide
  type: Documentation
- url: https://developer.availity.com/partner/contact-us
  type: Support
- url: https://www.availity.com/terms-of-use/
  type: TermsOfService
- url: https://www.availity.com/Privacy-Policy/
  type: PrivacyPolicy
- url: https://github.com/availity
  type: GitHubOrganization
- url: https://availity.github.io/sdk-js/
  type: SDKs
- url: https://raw.githubusercontent.com/api-evangelist/availity/refs/heads/main/json-schema/availity-eligibility-schema.json
  type: JSONSchema
- url: https://raw.githubusercontent.com/api-evangelist/availity/refs/heads/main/json-ld/availity-eligibility-context.jsonld
  type: JSONLD
- url: https://raw.githubusercontent.com/api-evangelist/availity/refs/heads/main/json-ld/availity-claim-context.jsonld
  type: JSONLD
- url: https://raw.githubusercontent.com/api-evangelist/availity/refs/heads/main/json-ld/availity-service-context.jsonld
  type: JSONLD
- url: https://raw.githubusercontent.com/api-evangelist/availity/refs/heads/main/rules/availity-spectral-rules.yml
  type: SpectralRules
- url: https://raw.githubusercontent.com/api-evangelist/availity/refs/heads/main/vocabulary/availity-vocabulary.yaml
  type: Vocabulary
- type: Features
  data:
  - name: OAuth 2.0 Authentication
    description: Client credentials grant flow with 5-minute token expiration and HTTPS/TLS encryption for secure API access.
  - name: Real-Time EDI Transactions
    description: Processing over 8.8 million daily transactions and 11 billion annual healthcare transactions across all major
      health plans.
  - name: Nationwide Payer Network
    description: Access to every major health plan nationwide and over 1 million providers through the Availity clearinghouse.
  - name: Multi-Format Responses
    description: Returns JSON and XML representations including errors using HTTP response codes. Supports CSV, PDF, PNG,
      and XLS for specific endpoints.
  - name: Cursor-Based Pagination
    description: Collection resources support offset/limit pagination with limit range of 1-50 items per request with link
      relations.
  - name: Mock/Sandbox Testing
    description: Demo subscriptions support custom response selection via X-Api-Mock-Scenario-ID and X-Api-Mock-Response headers.
  - name: Rate Limiting
    description: Standard tier provides 100,000 calls per day and 100 calls per second for HIPAA transaction APIs.
  - name: ASC X12 EDI Standards
    description: Full support for HIPAA EDI version 005010 transactions including 270/271, 276/277, 278, and 835 transaction
      sets.
- type: UseCases
  data:
  - name: Real-Time Eligibility Verification
    description: Verify patient insurance coverage, co-pays, deductibles, and benefits in real time before scheduling or rendering
      services.
  - name: Claim Status Tracking
    description: Track submitted claims through adjudication, checking ACKNOWLEDGED, PENDING, PAID, DENIED, and ADJUSTED statuses.
  - name: Prior Authorization Management
    description: Submit and track prior authorization requests using X12 278 transactions to check if authorization is required
      before service delivery.
  - name: Patient Cost Estimation
    description: Estimate patient out-of-pocket costs before services are rendered to meet price transparency requirements
      and inform patients.
  - name: Electronic Claim Attachments
    description: Electronically attach clinical documentation to claims and authorizations, reducing manual faxing and accelerating
      adjudication.
  - name: Care Gap Identification
    description: Retrieve real-time care reminders during eligibility checks to identify preventive care gaps and coordinate
      outreach.
  - name: Digital Member ID Cards
    description: Retrieve member ID cards digitally during eligibility verification, reducing administrative burden and improving
      patient experience.
  - name: Multi-Payer Data Consolidation
    description: Connect to all major payers through a single clearinghouse API rather than managing individual payer connections.
- type: Integrations
  data:
  - name: EHR Systems
    description: Integrates with electronic health record systems to embed eligibility and claims workflows into clinical
      workflows.
  - name: Practice Management Systems
    description: Connects practice management software to payer networks for revenue cycle management and claims processing.
  - name: Revenue Cycle Management Platforms
    description: Integrates with RCM platforms to automate eligibility verification, claim submission, and payment reconciliation.
  - name: Blue Cross Blue Shield Plans
    description: Direct integration with BCBS plans nationwide for eligibility, claims, and prior authorization transactions.
  - name: Humana
    description: Integration with Humana for care reminders, eligibility verification, and claims processing.
  - name: Molina Healthcare
    description: Integration with Molina Healthcare for eligibility and benefits verification and care reminders.
  - name: Florida Blue
    description: Integration with Florida Blue for care reminders and real-time eligibility verification.
  - name: Healthfirst New York
    description: Integration with Healthfirst New York for eligibility and care gap identification.
- type: ArazzoWorkflows
  workflows:
  - url: arazzo/availity-claim-attachment-workflow.yml
    name: Availity Claim Attachment (X12 275)
    summary: Submit an X12 275 claim attachment, then poll for its processing status until the payer accepts it.
  - url: arazzo/availity-claim-status-inquiry-workflow.yml
    name: Availity Claim Status Inquiry (X12 276/277)
    summary: Submit an X12 276 claim status request, then poll for the X12 277 claim status response until the payer finalizes
      it.
  - url: arazzo/availity-eligibility-benefits-workflow.yml
    name: 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.
  - url: arazzo/availity-prior-authorization-workflow.yml
    name: Availity Prior Authorization (X12 278)
    summary: Determine whether authorization is required, create the X12 278 service review, attach supporting clinical documentation,
      then read back the authorization decision.
- type: AgenticAccess
  url: agentic-access/availity-agentic-access.yml
- type: DomainSecurity
  url: security/availity-domain-security.yml
- type: Authentication
  url: authentication/availity-authentication.yml
- type: OAuthScopes
  url: scopes/availity-scopes.yml
- type: DeveloperPortal
  url: https://developer.availity.com/
- type: APIReference
  url: https://developer.availity.com/portal/catalogue-products/healthcare-hipaa-transactions-1
- type: Blog
  url: https://www.availity.com/blog/
- type: SignUp
  url: https://developer.availity.com/portal/user/login
- type: Compliance
  url: https://www.availity.com/regulatory-compliance/
- type: StatusPage
  url: https://status.availity.com
- type: Packages
  url: packages/availity-packages.yml
- type: SDKs
  url: packages/availity-packages.yml
- type: CLI
  url: cli/availity-cli.yml
- type: Components
  url: components/availity-components.yml
- type: Sandbox
  url: sandbox/availity-sandbox.yml
- type: Conventions
  url: conventions/availity-conventions.yml
- type: ErrorCatalog
  url: errors/availity-problem-types.yml
- type: Lifecycle
  url: lifecycle/availity-lifecycle.yml
- type: Conformance
  url: conformance/availity-conformance.yml
- type: DataModel
  url: data-model/availity-data-model.yml
- type: Plans
  url: plans/availity-plans-pricing.yml
- type: RateLimits
  url: rate-limits/availity-rate-limits.yml
- type: FinOps
  url: finops/availity-finops.yml
- type: AgentSkill
  url: skills/_index.yml
- type: LLMsTxt
  url: llms/availity-llms.txt
- type: OpenAPI
  url: openapi/_harvested/availity-aws-payer-list-swagger.json
  name: Availity AWS Payer List (Swagger 2.0, first-party)
- type: OpenAPI
  url: openapi/_harvested/availity-care-cost-estimator-institutional-swagger.json
  name: Availity Patient Cost Estimator 1.0.0 - Institutional (Swagger 2.0, first-party)
- type: OpenAPI
  url: openapi/_harvested/availity-care-cost-estimator-professional-swagger.json
  name: Availity Patient Cost Estimator 1.0.0 - Professional (Swagger 2.0, first-party)
- type: OpenAPI
  url: openapi/_harvested/availity-claim-statuses-swagger.json
  name: Availity Claim Statuses (Swagger 2.0, first-party)
- type: OpenAPI
  url: openapi/_harvested/availity-configurations-swagger.json
  name: Availity Configurations (Swagger 2.0, first-party)
- type: OpenAPI
  url: openapi/_harvested/availity-coverages-swagger.json
  name: Availity Coverages (Swagger 2.0, first-party)
- type: OpenAPI
  url: openapi/_harvested/availity-dental-claims-swagger.json
  name: Availity Dental Claims (Swagger 2.0, first-party)
- type: OpenAPI
  url: openapi/_harvested/availity-dfs-swagger.json
  name: Availity Dfs (Swagger 2.0, first-party)
- type: OpenAPI
  url: openapi/_harvested/availity-patient-cost-estimator-professional-swagger.json
  name: Availity Patient Cost Estimator 2.0.0 - Professional (Swagger 2.0, first-party)
- type: OpenAPI
  url: openapi/_harvested/availity-payer-list-swagger.json
  name: Availity Payer List (Swagger 2.0, first-party)
- type: OpenAPI
  url: openapi/_harvested/availity-service-reviews-swagger.json
  name: Availity Service Reviews (Swagger 2.0, first-party)
- type: Overlay
  url: overlays/availity-aws-payer-list-overlay.yaml
  name: API Evangelist enhancements for Availity AWS Payer List
- type: Overlay
  url: overlays/availity-care-cost-estimator-institutional-overlay.yaml
  name: API Evangelist enhancements for Availity Patient Cost Estimator 1.0.0 - Institutional
- type: Overlay
  url: overlays/availity-care-cost-estimator-professional-overlay.yaml
  name: API Evangelist enhancements for Availity Patient Cost Estimator 1.0.0 - Professional
- type: Overlay
  url: overlays/availity-claim-statuses-overlay.yaml
  name: API Evangelist enhancements for Availity Claim Statuses
- type: Overlay
  url: overlays/availity-configurations-overlay.yaml
  name: API Evangelist enhancements for Availity Configurations
- type: Overlay
  url: overlays/availity-coverages-overlay.yaml
  name: API Evangelist enhancements for Availity Coverages
- type: Overlay
  url: overlays/availity-dental-claims-overlay.yaml
  name: API Evangelist enhancements for Availity Dental Claims
- type: Overlay
  url: overlays/availity-dfs-overlay.yaml
  name: API Evangelist enhancements for Availity Dfs
- type: Overlay
  url: overlays/availity-patient-cost-estimator-professional-overlay.yaml
  name: API Evangelist enhancements for Availity Patient Cost Estimator 2.0.0 - Professional
- type: Overlay
  url: overlays/availity-payer-list-overlay.yaml
  name: API Evangelist enhancements for Availity Payer List
- type: Overlay
  url: overlays/availity-service-reviews-overlay.yaml
  name: API Evangelist enhancements for Availity Service Reviews
maintainers:
- name: Kin Lane
  email: kin@apievangelist.com
modified: '2026-08-15'
description: Availity is a healthcare information network and clearinghouse providing REST APIs for real-time HIPAA EDI transactions.
  The platform processes over 11 billion annual healthcare transactions connecting providers, health plans, and vendors nationwide.
  Create your application and subscribe to a plan to make use of Availity APIs for eligibility verification, claims management,
  prior authorization, and patient cost estimation.
x-enrichment:
  date: '2026-08-15'
  status: enriched
  artifacts_added: 23
  pass: local-v1