generated: '2026-08-15' method: derived source: openapi/_harvested/*-swagger.json (Availity's own published Swagger 2.0 documents, harvested 2026-08-14) docs: https://developer.availity.com/blog/2025/3/25/availity-api-guide provider: Availity providerId: availity summary: >- The entity-relationship graph of Availity's public REST surface, derived mechanically from the `definitions` blocks of the eleven first-party Swagger 2.0 documents Availity publishes. Every entity, field count, identifier field and relationship below was read out of Availity's own documents; nothing is inferred from prose. shape_notes: - >- THERE IS NO SHARED MODEL ACROSS PRODUCTS. Each Availity API document defines its OWN copy of the common healthcare entities — Patient, Payer, Provider, Subscriber, Submitter, ServiceLine, Diagnosis, Note, ErrorResponse, FieldError, Link, ResultSet all recur, with DIFFERENT field sets, in Coverages, Claim Statuses, Service Reviews and Dental Claims. There is no `components.schemas` reuse across products because each document is generated per product by the gateway. A client cannot write one Payer type and reuse it; it needs a per-product type. - >- NO CROSS-RESOURCE ID GRAPH. Availity's resources are TRANSACTION envelopes, not persistent domain objects. A Coverage does not reference a Claim, a ClaimStatus does not reference a ServiceReview, and there is no customer/account object at the root. The only durable identifier is the per-transaction `id` returned by a POST, which is then polled on the GET. Correlation across transactions is done on X12 business identifiers carried INSIDE the payload (member id, control number, patientAccountNumber, payer claim number), not on API-level ids. - >- THE ROOT ENTITIES ARE THE X12 TRANSACTIONS. Coverage (270/271), ClaimStatus (276/277), ServiceReview (278), DentalClaim, InstitutionalClaim, ProfessionalClaim / ProfessionalPCERequest, Configuration and Payer. Everything else hangs off one of these. - >- EVERY DOCUMENT SHARES ONE ERROR SHAPE: ErrorResponse has_many FieldError. That is the single genuinely universal relationship in the estate. See errors/availity-problem-types.yml. - >- COLLECTION RESPONSES WRAP IN ResultSet. Coverages, Claim Statuses, Service Reviews and Configurations each define a ResultSet whose array member is named for the plural resource (`coverages`, `claimStatuses`, `serviceReviews`, `configurations`) — the pagination contract described in conventions/availity-conventions.yml. - >- THE BENEFITS GRAPH IS THE DEEPEST STRUCTURE IN THE ESTATE. Coverage -> Benefit -> Amounts -> BenefitDetail -> NetworkBenefit is four levels of nesting, and BenefitDetail fans out into inNetwork / outOfNetwork / noNetwork / notApplicableNetwork arrays of NetworkBenefit. Anyone reading co-pay or deductible values must walk all four network buckets, not just `inNetwork`. - >- THE DENTAL CLAIM IS THE WIDEST. DentalClaim -> ClaimInformation carries twelve relationships including six distinct provider roles (rendering, referring, supervising, assistant surgeon, primary care, service facility), and ServiceLine repeats four of those roles at line level. render: null counts: specs_read: 11 entities: 106 relationship_bearing_entities: 39 entities: - name: Payer spec: availity-aws-payer-list-swagger.json field_count: 5 identifier_fields: - payerId - name: Diagnosis spec: availity-care-cost-estimator-institutional-swagger.json field_count: 5 identifier_fields: - code - presentOnAdmissionIndicatorCode - qualifierCode - name: ErrorResponse spec: availity-care-cost-estimator-institutional-swagger.json field_count: 5 identifier_fields: - reasonCode - statusCode relationships: - kind: has_many via: errors target: FieldError - name: FieldError spec: availity-care-cost-estimator-institutional-swagger.json field_count: 4 identifier_fields: - code - name: InstitutionalClaim spec: availity-care-cost-estimator-institutional-swagger.json field_count: 13 identifier_fields: - customerId - id - requestTypeCode - name: ItemDescription spec: availity-care-cost-estimator-institutional-swagger.json field_count: 6 identifier_fields: - code - name: Procedure spec: availity-care-cost-estimator-institutional-swagger.json field_count: 5 identifier_fields: - code - qualifierCode - name: AmbulanceCertification spec: availity-care-cost-estimator-professional-swagger.json field_count: 6 - name: ClaimAdjustmentGroup spec: availity-care-cost-estimator-professional-swagger.json field_count: 2 identifier_fields: - groupCode - name: ErrorResponse spec: availity-care-cost-estimator-professional-swagger.json field_count: 5 identifier_fields: - reasonCode - statusCode relationships: - kind: has_many via: errors target: FieldError - name: FieldError spec: availity-care-cost-estimator-professional-swagger.json field_count: 4 identifier_fields: - code - name: ItemDescription spec: availity-care-cost-estimator-professional-swagger.json field_count: 6 identifier_fields: - code - name: PhysicalLocation spec: availity-care-cost-estimator-professional-swagger.json field_count: 7 identifier_fields: - countryCode - stateCode - zipCode - name: ProfessionalClaim spec: availity-care-cost-estimator-professional-swagger.json field_count: 14 identifier_fields: - customerId - id - requestTypeCode relationships: - kind: has_one via: subscriber target: Subscriber - name: Provider spec: availity-care-cost-estimator-professional-swagger.json field_count: 21 identifier_fields: - countryCode - locationNumber - payerAssignedProviderId - specialtyCode - stateCode - stateLicenseNumber - zipCode - name: Subscriber spec: availity-care-cost-estimator-professional-swagger.json field_count: 19 identifier_fields: - countryCode - groupNumber - memberId - stateCode - zipCode relationships: - kind: has_many via: holdReasons target: ItemDescription - name: SupplementalInformation spec: availity-care-cost-estimator-professional-swagger.json field_count: 3 identifier_fields: - controlNumber - reportTransmissionCode - reportTypeCode - name: ClaimStatus spec: availity-claim-statuses-swagger.json field_count: 24 identifier_fields: - claimNumber - controlNumber - customerId - facilityTypeCode - frequencyTypeCode - id - statusCode - userId relationships: - kind: has_many via: claimStatuses target: ClaimStatusResult - kind: has_one via: patient target: Patient - kind: has_one via: payer target: Payer - kind: has_many via: providers target: Provider - kind: has_one via: submitter target: Submitter - kind: has_one via: subscriber target: Subscriber - name: ClaimStatusDetail spec: availity-claim-statuses-swagger.json field_count: 14 identifier_fields: - categoryCode - checkNumber - entityCode - statusCode - name: ClaimStatusResult spec: availity-claim-statuses-swagger.json field_count: 14 identifier_fields: - claimControlNumber - claimIdentificationNumber - facilityTypeCode - frequencyTypeCode - patientControlNumber - pharmacyPrescriptionNumber - traceId - voucherNumber relationships: - kind: has_many via: serviceLines target: ServiceLine - kind: has_many via: statusDetails target: ClaimStatusDetail - name: ClaimStatusSummary spec: availity-claim-statuses-swagger.json field_count: 22 identifier_fields: - claimNumber - controlNumber - customerId - facilityTypeCode - frequencyTypeCode - id - statusCode - name: ErrorResponse spec: availity-claim-statuses-swagger.json field_count: 5 identifier_fields: - reasonCode - statusCode relationships: - kind: has_many via: errors target: FieldError - name: FieldError spec: availity-claim-statuses-swagger.json field_count: 4 identifier_fields: - code - name: Link spec: availity-claim-statuses-swagger.json field_count: 1 - name: Patient spec: availity-claim-statuses-swagger.json field_count: 10 identifier_fields: - accountNumber - genderCode - subscriberRelationshipCode - name: Payer spec: availity-claim-statuses-swagger.json field_count: 8 identifier_fields: - ediAccessNumber - id - name: Provider spec: availity-claim-statuses-swagger.json field_count: 9 identifier_fields: - payerAssignedProviderId - taxId - traceId relationships: - kind: has_many via: statusDetails target: ClaimStatusDetail - name: ResultSet spec: availity-claim-statuses-swagger.json field_count: 6 relationships: - kind: has_many via: claimStatuses target: ClaimStatusSummary - name: ServiceLine spec: availity-claim-statuses-swagger.json field_count: 23 identifier_fields: - controlNumber - modifier1Code - modifier2Code - modifier3Code - modifier4Code - procedureCode - procedureQualifierCode - serviceCode relationships: - kind: has_many via: statusDetails target: ClaimStatusDetail - name: Submitter spec: availity-claim-statuses-swagger.json field_count: 7 identifier_fields: - id - traceId relationships: - kind: has_many via: statusDetails target: ClaimStatusDetail - name: Subscriber spec: availity-claim-statuses-swagger.json field_count: 6 identifier_fields: - memberId - taxId - name: Configuration spec: availity-configurations-swagger.json field_count: 12 identifier_fields: - categoryId - payerId - sourceId - subtypeId - name: Element spec: availity-configurations-swagger.json field_count: 30 identifier_fields: - helpTopicId - name: ErrorResponse spec: availity-configurations-swagger.json field_count: 5 identifier_fields: - reasonCode - statusCode relationships: - kind: has_many via: errors target: FieldError - name: FieldCondition spec: availity-configurations-swagger.json field_count: 9 - name: FieldError spec: availity-configurations-swagger.json field_count: 4 identifier_fields: - code - name: Link spec: availity-configurations-swagger.json field_count: 1 - name: ObjectType spec: availity-configurations-swagger.json field_count: 9 - name: ResultSet spec: availity-configurations-swagger.json field_count: 6 relationships: - kind: has_many via: configurations target: Configuration - name: Address spec: availity-coverages-swagger.json field_count: 6 identifier_fields: - stateCode - zipCode - name: Amounts spec: availity-coverages-swagger.json field_count: 4 relationships: - kind: has_one via: coInsurance target: BenefitDetail - kind: has_one via: coPayment target: BenefitDetail - kind: has_one via: deductibles target: BenefitDetail - kind: has_one via: outOfPocket target: BenefitDetail - name: Benefit spec: availity-coverages-swagger.json field_count: 18 identifier_fields: - statusCode relationships: - kind: has_many via: additionalPayers target: Payer - kind: has_one via: amounts target: Amounts - kind: has_one via: benefitDescriptions target: BenefitDetail - kind: has_many via: contacts target: HealthCareContact - kind: has_one via: costContainment target: BenefitDetail - kind: has_one via: coverageBasis target: BenefitDetail - kind: has_one via: exclusions target: BenefitDetail - kind: has_one via: limitations target: BenefitDetail - kind: has_one via: nonCovered target: BenefitDetail - kind: has_many via: payerNotes target: PayerNote - kind: has_one via: preexistingConditions target: BenefitDetail - kind: has_one via: reserve target: BenefitDetail - kind: has_one via: statusDetails target: BenefitDetail - name: BenefitDetail spec: availity-coverages-swagger.json field_count: 4 relationships: - kind: has_many via: inNetwork target: NetworkBenefit - kind: has_many via: noNetwork target: NetworkBenefit - kind: has_many via: notApplicableNetwork target: NetworkBenefit - kind: has_many via: outOfNetwork target: NetworkBenefit - name: ContactInformation spec: availity-coverages-swagger.json field_count: 7 identifier_fields: - ediAccessNumber - name: Coverage spec: availity-coverages-swagger.json field_count: 22 identifier_fields: - controlNumber - customerId - id - procedureCode - statusCode - submitterStatecode relationships: - kind: has_one via: payer target: Payer - kind: has_one via: requestingProvider target: HealthCareContact - kind: has_many via: validationMessages target: FieldError - name: CoverageSummary spec: availity-coverages-swagger.json field_count: 20 identifier_fields: - controlNumber - customerId - id - procedureCode - statusCode - submitterStatecode relationships: - kind: has_many via: validationMessages target: FieldError - name: ErrorResponse spec: availity-coverages-swagger.json field_count: 5 identifier_fields: - reasonCode - statusCode relationships: - kind: has_many via: errors target: FieldError - name: FieldError spec: availity-coverages-swagger.json field_count: 4 identifier_fields: - code - name: HealthCareContact spec: availity-coverages-swagger.json field_count: 78 identifier_fields: - alternateListId - categoryCode - contractNumber - coverageListlId - drugFormularyNumber - facilityId - facilityNetworkId - familyUnitNumber - groupNumber - healthInsuranceClaimNumber - medicaidProviderNumber - medicaidRecipientId relationships: - kind: has_one via: address target: Address - kind: has_many via: contactInformation target: ContactInformation - kind: has_many via: deliveryInformation target: HealthCareServiceDelivery - name: HealthCareServiceDelivery spec: availity-coverages-swagger.json field_count: 13 identifier_fields: - patternCode - perCode - quantityQualifierCode - timeCode - timePeriodCode - name: Link spec: availity-coverages-swagger.json field_count: 1 - name: NetworkBenefit spec: availity-coverages-swagger.json field_count: 62 identifier_fields: - amountTimePeriodCode - familyUnitNumber - groupNumber - healthInsuranceClaimNumber - insurancePolicyNumber - insuranceTypeCode - levelCode - medicaidRecipientIdentificationNumber - memberIdentificationNumber - placeOfServiceCode - planNetworkId - planNumber relationships: - kind: has_many via: contacts target: ContactInformation - kind: has_many via: deliveryInformation target: HealthCareServiceDelivery - name: Payer spec: availity-coverages-swagger.json field_count: 52 identifier_fields: - familyUnitNumber - groupNumber - healthInsuranceClaimNumber - insuredMemberId - medicaidRecipientIdentificationNumber - memberIdentificationNumber - payerId - planNetworkId - planNumber - policyNumber - responsePayerId - serviceTypeCode relationships: - kind: has_one via: address target: Address - kind: has_many via: contactInformation target: ContactInformation - kind: has_one via: insuredAddress target: Address - kind: has_many via: insuredContactInformation target: ContactInformation - name: PayerNote spec: availity-coverages-swagger.json field_count: 3 identifier_fields: - typeCode - name: ResultSet spec: availity-coverages-swagger.json field_count: 6 relationships: - kind: has_many via: coverages target: CoverageSummary - name: AdjudicationInformation spec: availity-dental-claims-swagger.json field_count: 13 identifier_fields: - lineNumber - payerId - procedureCode relationships: - kind: has_many via: claimAdjustmentGroups target: AdjustmentGroup - name: Adjustment spec: availity-dental-claims-swagger.json field_count: 3 identifier_fields: - reasonCode - name: AdjustmentGroup spec: availity-dental-claims-swagger.json field_count: 2 identifier_fields: - groupCode relationships: - kind: has_many via: adjustments target: Adjustment - name: BillingProvider spec: availity-dental-claims-swagger.json field_count: 24 identifier_fields: - countryCode - locationNumber - payerAssignedProviderId - specialtyCode - stateCode - stateLicenseNumber - zipCode - name: ClaimInformation spec: availity-dental-claims-swagger.json field_count: 42 identifier_fields: - accidentStateCode - contractCode - contractTypeCode - controlNumber - delayReasonCode - frequencyTypeCode - informationReleaseCode - payerClaimControlNumber - placeOfServiceCode - priorAuthorizationNumber - providerAcceptAssignmentCode - serviceAuthorizationExceptionCode relationships: - kind: has_one via: assistantSurgeon target: Provider - kind: has_many via: diagnoses target: Diagnosis - kind: has_many via: notes target: Note - kind: has_many via: otherPayers target: OtherPayer - kind: has_one via: primaryCareProvider target: Provider - kind: has_one via: referringProvider target: Provider - kind: has_one via: renderingProvider target: Provider - kind: has_one via: serviceFacility target: Provider - kind: has_many via: serviceLines target: ServiceLine - kind: has_one via: supervisingProvider target: Provider - kind: has_many via: supplementalInformation target: SupplementalInformation - kind: has_many via: toothStatuses target: ToothStatus - name: DentalClaim spec: availity-dental-claims-swagger.json field_count: 13 identifier_fields: - customerId - id - requestTypeCode relationships: - kind: has_one via: billingProvider target: BillingProvider - kind: has_one via: claimInformation target: ClaimInformation - kind: has_one via: patient target: Patient - kind: has_one via: payer target: Payer - kind: has_one via: submitter target: Submitter - kind: has_one via: subscriber target: Subscriber - name: Diagnosis spec: availity-dental-claims-swagger.json field_count: 2 identifier_fields: - code - qualifierCode - name: ErrorResponse spec: availity-dental-claims-swagger.json field_count: 5 identifier_fields: - reasonCode - statusCode relationships: - kind: has_many via: errors target: FieldError - name: FieldError spec: availity-dental-claims-swagger.json field_count: 4 identifier_fields: - code - name: Note spec: availity-dental-claims-swagger.json field_count: 1 - name: OtherPayer spec: availity-dental-claims-swagger.json field_count: 27 identifier_fields: - claimControlNumber - claimFilingIndicatorCode - claimOfficeNumber - countryCode - id - informationReleaseCode - insuranceTypeCode - naicCode - priorAuthorizationNumber - referralNumber - responsibilitySequenceCode - stateCode relationships: - kind: has_many via: claimAdjustmentGroups target: AdjustmentGroup - kind: has_one via: subscriber target: Subscriber - name: Patient spec: availity-dental-claims-swagger.json field_count: 14 identifier_fields: - agencyClaimNumber - countryCode - genderCode - stateCode - subscriberRelationshipCode - zipCode - name: Payer spec: availity-dental-claims-swagger.json field_count: 14 identifier_fields: - claimFilingIndicatorCode - claimOfficeNumber - countryCode - id - insuranceTypeCode - naicCode - responsibilitySequenceCode - stateCode - zipCode - name: Provider spec: availity-dental-claims-swagger.json field_count: 17 identifier_fields: - countryCode - locationNumber - payerAssignedProviderId - referralNumber - specialtyCode - stateCode - stateLicenseNumber - zipCode - name: ServiceLine spec: availity-dental-claims-swagger.json field_count: 41 identifier_fields: - contractCode - contractTypeCode - controlNumber - placeOfServiceCode - priorAuthorizationNumber - procedureCode - prostheticCode - referralNumber relationships: - kind: has_many via: adjudicationInformation target: AdjudicationInformation - kind: has_one via: assistantSurgeon target: Provider - kind: has_one via: renderingProvider target: Provider - kind: has_one via: serviceFacility target: Provider - kind: has_one via: supervisingProvider target: Provider - kind: has_many via: toothInformation target: ToothInformation - name: Submitter spec: availity-dental-claims-swagger.json field_count: 9 identifier_fields: - id - name: Subscriber spec: availity-dental-claims-swagger.json field_count: 14 identifier_fields: - countryCode - groupNumber - memberId - stateCode - zipCode - name: SupplementalInformation spec: availity-dental-claims-swagger.json field_count: 3 identifier_fields: - controlNumber - reportTransmissionCode - reportTypeCode - name: ToothInformation spec: availity-dental-claims-swagger.json field_count: 6 identifier_fields: - toothCode - name: ToothStatus spec: availity-dental-claims-swagger.json field_count: 2 identifier_fields: - toothCode - toothStatusCode - name: ErrorResponse spec: availity-dfs-swagger.json field_count: 5 identifier_fields: - reasonCode - statusCode relationships: - kind: has_many via: errors target: FieldError - name: FieldError spec: availity-dfs-swagger.json field_count: 4 identifier_fields: - code - name: AmbulanceCertification spec: availity-patient-cost-estimator-professional-swagger.json field_count: 6 - name: ClaimAdjustmentGroup spec: availity-patient-cost-estimator-professional-swagger.json field_count: 3 identifier_fields: - groupCode - name: CoveragePlanCandidates spec: availity-patient-cost-estimator-professional-swagger.json field_count: 1 - name: ErrorResponse spec: availity-patient-cost-estimator-professional-swagger.json field_count: 3 identifier_fields: - id relationships: - kind: has_many via: candidates target: CoveragePlanCandidates - name: ItemDescription spec: availity-patient-cost-estimator-professional-swagger.json field_count: 6 identifier_fields: - code - name: PhysicalLocation spec: availity-patient-cost-estimator-professional-swagger.json field_count: 7 identifier_fields: - countryCode - stateCode - zipCode - name: PollingResponse spec: availity-patient-cost-estimator-professional-swagger.json field_count: 2 identifier_fields: - id - name: ProfessionalClaimBase spec: availity-patient-cost-estimator-professional-swagger.json field_count: 5 relationships: - kind: has_one via: subscriber target: Subscriber - name: ProfessionalPCERequest spec: availity-patient-cost-estimator-professional-swagger.json field_count: 0 - name: ProfessionalPCEResponse spec: availity-patient-cost-estimator-professional-swagger.json field_count: 4 identifier_fields: - id - name: Provider spec: availity-patient-cost-estimator-professional-swagger.json field_count: 21 identifier_fields: - countryCode - locationNumber - payerAssignedProviderId - specialtyCode - stateCode - stateLicenseNumber - zipCode - name: Subscriber spec: availity-patient-cost-estimator-professional-swagger.json field_count: 19 identifier_fields: - countryCode - groupNumber - memberId - stateCode - zipCode relationships: - kind: has_many via: holdReasons target: ItemDescription - name: SupplementalInformation spec: availity-patient-cost-estimator-professional-swagger.json field_count: 3 identifier_fields: - controlNumber - reportTransmissionCode - reportTypeCode - name: Payer spec: availity-payer-list-swagger.json field_count: 5 identifier_fields: - payerId - name: Diagnosis spec: availity-service-reviews-swagger.json field_count: 5 identifier_fields: - code - qualifierCode - name: ErrorResponse spec: availity-service-reviews-swagger.json field_count: 5 identifier_fields: - reasonCode - statusCode relationships: - kind: has_many via: errors target: FieldError - name: FieldError spec: availity-service-reviews-swagger.json field_count: 4 identifier_fields: - code - name: Link spec: availity-service-reviews-swagger.json field_count: 1 - name: Note spec: availity-service-reviews-swagger.json field_count: 3 identifier_fields: - typeCode - name: Patient spec: availity-service-reviews-swagger.json field_count: 22 identifier_fields: - conditionCode - genderCode - prognosisCode - stateCode - statusCode - subscriberRelationshipCode - zipCode - name: Payer spec: availity-service-reviews-swagger.json field_count: 8 identifier_fields: - id - name: Procedures spec: availity-service-reviews-swagger.json field_count: 29 identifier_fields: - certificationNumber - code - qualifierCode - quantityTypeCode - revenueCode - statusCode relationships: - kind: has_many via: notes target: Note - name: RenderingProvider spec: availity-service-reviews-swagger.json field_count: 23 identifier_fields: - payerAssignedProviderId - roleCode - specialtyCode - stateCode - taxId - zipCode - name: RequestingProvider spec: availity-service-reviews-swagger.json field_count: 22 identifier_fields: - payerAssignedProviderId - specialtyCode - stateCode - submitterId - taxId - zipCode - name: ResultSet spec: availity-service-reviews-swagger.json field_count: 6 relationships: - kind: has_many via: serviceReviews target: ServiceReview - name: ServiceReview spec: availity-service-reviews-swagger.json field_count: 75 identifier_fields: - admissionSourceCode - admissionTypeCode - beginningSubluxationLevelCode - certificationNumber - controlNumber - customerId - endingSubluxationLevelCode - id - nursingHomeResidentialStatusCode - oxygenDeliverySystemTypeCode - oxygenEquipmentTypeCode - placeOfServiceCode relationships: - kind: has_many via: diagnoses target: Diagnosis - kind: has_one via: patient target: Patient - kind: has_one via: payer target: Payer - kind: has_many via: payerNotes target: Note - kind: has_many via: procedures target: Procedures - kind: has_many via: providerNotes target: Note - kind: has_many via: renderingProviders target: RenderingProvider - kind: has_one via: requestingProvider target: RequestingProvider - kind: has_one via: subscriber target: Subscriber - kind: has_one via: supplementalInformation target: SupplementalInformation - kind: has_many via: transportLocations target: TransportLocation - kind: has_many via: validationMessages target: FieldError - name: Subscriber spec: availity-service-reviews-swagger.json field_count: 11 identifier_fields: - memberId - stateCode - zipCode - name: SupplementalInformation spec: availity-service-reviews-swagger.json field_count: 5 identifier_fields: - refAuthNumber relationships: - kind: has_many via: diagnoses target: Diagnosis - kind: has_many via: procedures target: Diagnosis - name: TransportLocation spec: availity-service-reviews-swagger.json field_count: 7 identifier_fields: - stateCode - zipCode maintainers: - FN: Kin Lane email: kin@apievangelist.com