Availity Eligibility Response

{
  "$schema": "https://json-schema.org/draft/2020-12/schema",
  "$id": "https://raw.githubusercontent.com/api-evangelist/availity/refs/heads/main/json-schema/availity-eligibility-schema.json",
  "title": "Availity Eligibility Response",
  "description": "JSON Schema for an Availity healthcare eligibility and benefits response (equivalent to X12 271 transaction).",
  "type": "object",
  "required": ["id", "subscriber", "payer"],
  "properties": {
    "id": {
      "type": "string",
      "description": "Availity transaction identifier"
    },
    "controlNumber": {
      "type": "string",
      "description": "Transaction control number matching the request",
      "maxLength": 9
    },
    "requestedDate": {
      "type": "string",
      "format": "date-time"
    },
    "serviceDate": {
      "type": "string",
      "format": "date"
    },
    "subscriber": {
      "$ref": "#/$defs/SubscriberInfo"
    },
    "payer": {
      "$ref": "#/$defs/PayerInfo"
    },
    "coverages": {
      "type": "array",
      "items": {
        "$ref": "#/$defs/Coverage"
      }
    },
    "planInformation": {
      "$ref": "#/$defs/PlanInformation"
    }
  },
  "$defs": {
    "SubscriberInfo": {
      "type": "object",
      "required": ["memberId"],
      "properties": {
        "memberId": {"type": "string"},
        "firstName": {"type": "string"},
        "lastName": {"type": "string"},
        "dateOfBirth": {"type": "string", "format": "date"},
        "gender": {"type": "string", "enum": ["M", "F", "U"]},
        "groupNumber": {"type": "string"},
        "groupName": {"type": "string"}
      }
    },
    "PayerInfo": {
      "type": "object",
      "required": ["id", "name"],
      "properties": {
        "id": {"type": "string", "description": "Availity payer ID"},
        "name": {"type": "string"}
      }
    },
    "Coverage": {
      "type": "object",
      "properties": {
        "serviceTypeCodes": {
          "type": "array",
          "items": {"type": "string"},
          "description": "X12 service type codes (e.g., 30=Health Benefit Plan, 1=Medical)"
        },
        "serviceTypeNames": {
          "type": "array",
          "items": {"type": "string"}
        },
        "coverageStatus": {
          "type": "string",
          "enum": ["Active", "Inactive", "Cancelled"]
        },
        "effectiveDate": {"type": "string", "format": "date"},
        "expirationDate": {"type": "string", "format": "date"},
        "benefits": {
          "type": "array",
          "items": {"$ref": "#/$defs/Benefit"}
        }
      }
    },
    "Benefit": {
      "type": "object",
      "properties": {
        "code": {
          "type": "string",
          "description": "X12 benefit info code (e.g., 1=Active Coverage, C=Deductible, G=Co-payment)"
        },
        "name": {"type": "string"},
        "coverageLevel": {
          "type": "string",
          "enum": ["INDIVIDUAL", "FAMILY", "EMPLOYEE", "EMPLOYEE_AND_SPOUSE"]
        },
        "benefitAmount": {
          "type": "object",
          "properties": {
            "value": {"type": "number", "minimum": 0},
            "currency": {"type": "string"}
          }
        },
        "benefitPercent": {
          "type": "number",
          "minimum": 0,
          "maximum": 100
        },
        "inPlanNetworkIndicator": {
          "type": "string",
          "enum": ["Y", "N", "W"],
          "description": "Y=In-network, N=Out-of-network, W=Not applicable"
        },
        "timeQualifier": {
          "type": "string",
          "description": "Benefit period qualifier"
        }
      }
    },
    "PlanInformation": {
      "type": "object",
      "properties": {
        "planName": {"type": "string"},
        "groupName": {"type": "string"},
        "groupNumber": {"type": "string"},
        "planBeginDate": {"type": "string", "format": "date"},
        "planEndDate": {"type": "string", "format": "date"}
      }
    }
  }
}