vocabulary: 1.0.0 info: provider: Availity description: Unified vocabulary for Availity healthcare clearinghouse APIs covering HIPAA EDI transactions, eligibility verification, claims management, and prior authorization. created: '2026-04-19' modified: '2026-04-19' operational: apis: - name: Availity Eligibility & Benefits API namespace: availity-eligibility version: 1.0.0 baseUrl: https://api.availity.com status: active - name: Availity Claim Status API namespace: availity-claims version: 1.0.0 baseUrl: https://api.availity.com status: active - name: Availity Claim Attachments API namespace: availity-attachments version: 1.0.0 baseUrl: https://api.availity.com status: active - name: Availity Service Reviews API namespace: availity-auth version: 2.0.0 baseUrl: https://api.availity.com status: active - name: Availity Patient Cost Estimator API namespace: availity-cost version: 2.0.0 baseUrl: https://api.availity.com status: active - name: Availity Payer List API namespace: availity-payers version: 1.0.4 baseUrl: https://api.availity.com status: active - name: Availity Configurations API namespace: availity-config version: 1.0.0 baseUrl: https://api.availity.com status: active resources: - name: eligibilities apis: - availity-eligibility actions: - check - list - get description: Member insurance eligibility and benefits inquiries - name: payers apis: - availity-eligibility - availity-payers actions: - list description: Health plan payers supported for transactions - name: claim-statuses apis: - availity-claims actions: - create - list - search - detail-search description: Claim status inquiries and tracking - name: claim-attachments apis: - availity-attachments actions: - submit - get description: Electronic claim attachment submission - name: service-reviews apis: - availity-auth actions: - create - list - get description: Prior authorization and service review requests - name: auth-requirements apis: - availity-auth actions: - check description: Authorization requirement checks per payer - name: cost-estimates apis: - availity-cost actions: - estimate description: Patient cost estimates for procedures - name: configurations apis: - availity-config actions: - get description: Payer-specific validation requirements actions: - name: check httpMethod: POST pattern: write description: Submit an inquiry or check - name: list httpMethod: GET pattern: read description: List collection of resources - name: get httpMethod: GET pattern: read description: Get a specific resource by ID - name: create httpMethod: POST pattern: write description: Create a new resource - name: submit httpMethod: POST pattern: write description: Submit a document or request - name: search httpMethod: POST pattern: query description: Search with criteria - name: estimate httpMethod: POST pattern: query description: Calculate cost estimates schemas: core: - name: EligibilityRequest description: X12 270 eligibility inquiry request - name: EligibilityResponse description: X12 271 eligibility response with benefits - name: ClaimStatusRequest description: X12 276 claim status inquiry request - name: ClaimStatusResponse description: X12 277 claim status response - name: ServiceReviewRequest description: X12 278 prior authorization request - name: ServiceReviewResponse description: X12 278 prior authorization response reference: - name: Payer description: Health plan payer identifier and metadata - name: Provider description: Healthcare provider with NPI and tax ID - name: Subscriber description: Insurance subscriber demographics and member ID financial: - name: Coverage description: Insurance coverage details with benefits - name: Benefit description: Specific benefit with amounts and coverage level - name: PlanInformation description: Health plan details and effective dates parameters: pagination: - name: limit type: integer description: Results per page (1-50) - name: offset type: integer description: Pagination offset filters: - name: fromDate type: string format: date description: Start date filter - name: toDate type: string format: date description: End date filter - name: payerId type: string description: Filter by health plan payer ID identifiers: - name: id type: string description: Availity transaction ID - name: npi type: string description: National Provider Identifier (10 digits) - name: memberId type: string description: Insurance member ID - name: controlNumber type: string description: X12 transaction control number (max 9 chars) enums: claim-statuses: - ACKNOWLEDGED - ACTION_REQUIRED - ADJUSTED - CAPITATED - DENIED - ERROR - FINALIZED - PAID - PENDING - REJECTED - RETURNED_TO_PROVIDER coverage-statuses: - Active - Inactive - Cancelled coverage-levels: - INDIVIDUAL - FAMILY - EMPLOYEE - EMPLOYEE_AND_SPOUSE service-review-statuses: - PENDING - APPROVED - DENIED - PARTIALLY_APPROVED - PENDING_ADDITIONAL_INFO attachment-statuses: - SUBMITTED - AV_ACCEPTED - AV_REJECTED - PY_ACCEPTED - PY_REJECTED genders: - M - F - U supported-transactions: - eligibility - claimStatus - priorAuth - remittance authentication: scheme: OAuth 2.0 Client Credentials tokenUrl: https://api.availity.com/availity/v1/token tokenExpiry: 5 minutes scopes: - name: hipaa description: Access to HIPAA transaction APIs capability: workflows: - name: Healthcare Revenue Cycle Management file: capabilities/availity-revenue-cycle-management.yaml description: Unified workflow combining eligibility, claims, and authorization for RCM teams apisCombined: - Eligibility & Benefits - Claim Status - Service Reviews toolCount: 9 personas: - Billing Specialist - Revenue Cycle Manager personas: - id: billing-specialist name: Billing Specialist description: Manages claim submission, status tracking, and patient billing workflows: - Healthcare Revenue Cycle Management - id: revenue-cycle-manager name: Revenue Cycle Manager description: Oversees end-to-end revenue cycle including authorization, eligibility, and claim adjudication workflows: - Healthcare Revenue Cycle Management - id: ehr-developer name: EHR Developer description: Integrates Availity APIs into electronic health record and practice management systems workflows: - Healthcare Revenue Cycle Management domains: - name: Eligibility Verification description: Real-time insurance coverage and benefits verification resources: - eligibilities - payers - name: Claims Management description: Claim status tracking and attachment submission resources: - claim-statuses - claim-attachments - name: Prior Authorization description: Service review and authorization request management resources: - service-reviews - auth-requirements - name: Financial Estimation description: Patient cost estimation and price transparency resources: - cost-estimates namespaces: - name: availity-eligibility type: consumed port: - name: availity-claims type: consumed port: - name: availity-auth type: consumed port: - name: availity-rcm-api type: rest port: 8080 - name: availity-rcm-mcp type: mcp port: 9090 binds: - name: AVAILITY_CLIENT_ID description: Availity API client ID from developer portal - name: AVAILITY_CLIENT_SECRET description: Availity API client secret from developer portal crossReference: - resource: eligibilities operations: - check - list - get workflows: - Healthcare Revenue Cycle Management personas: - Billing Specialist - Revenue Cycle Manager - resource: claim-statuses operations: - create - search - detail-search workflows: - Healthcare Revenue Cycle Management personas: - Billing Specialist - Revenue Cycle Manager - resource: service-reviews operations: - check - create - get workflows: - Healthcare Revenue Cycle Management personas: - Revenue Cycle Manager - resource: payers operations: - list workflows: - Healthcare Revenue Cycle Management personas: - Billing Specialist - EHR Developer