Availity API
Availity is a healthcare information network and provider portal that connects payers and providers to verify coverage, submit and track claims, exchange authorizations and attachments, and reconcile payments. With an unofficial API, you could verify member eligibility in real time, submit prior aut
What is Availity?
Availity is one of the largest healthcare clearinghouses and provider portals, enabling secure, compliant data exchange between payers and providers. It centralizes workflows for eligibility and benefits (X12 270/271), claims submission (837P/I), claim status (276/277), remittances (835 ERA), prior authorization, attachments (275), referrals, and provider data management.
Core product areas include:
- Eligibility and benefits verification (270/271)
- Claims submission and EDI clearinghouse (837P/I)
- Claim status inquiry and tracking (276/277)
- Remittance advice and reconciliation (835 ERA)
- Prior authorization and clinical attachments (PA and 275)
- Payer spaces, messaging, and provider data management
- EFT/ERA enrollment and payer connectivity
Common data entities:
- Providers/Organizations (NPIs, taxonomy, addresses)
- Payers/Plans and product lines
- Members/Subscribers (patients)
- Claims (837P/I service lines, diagnoses, charges)
- Claim Status Acknowledgments (277)
- Remittances (835 ERA payments, adjustments, CARC/RARC codes)
- Authorizations (diagnoses, procedures, facilities, tracking numbers)
- Attachments (clinical documentation, indexing metadata)
- Trading partner enrollments (EFT/ERA, connectivity)
The Availity Integration Challenge
Organizations rely on Availity daily, but turning portal and EDI workflows into automated pipelines is hard:
- Payer- and plan-specific rules: Benefit structures, authorization triggers, and claim formatting vary widely by payer/product
- Strong enterprise security: SSO/MFA and network controls complicate headless automation
- Portal-first delivery: Key authorization, attachment, and payer messaging flows live in web apps or batch interfaces
- EDI timing windows and batching: 837/835/276/277 exchanges follow partner-defined schedules and processing windows
- Compliance nuances: HIPAA requirements for PHI, audit trails, attachment indexing, and retention must be respected
How Supergood Creates Availity APIs
Supergood reverse-engineers authenticated browser flows, EDI interfaces, and network interactions to deliver a resilient API endpoint layer.
- Handles username/password, SSO/OAuth, and MFA (SMS, email, TOTP) securely
- Maintains session continuity with automated refresh and change detection
- Normalizes eligibility, authorization, claim, and ERA objects across payers
- Aligns with customer entitlements and licensing constraints to ensure compliant access
- Bridges EDI, SFTP, and batch flows with signed URL retrieval and delivery
Getting Started
- Schedule Integration Assessment
Book a 30-minute session to confirm your Availity product mix, licensing, and authentication model.
- Supergood Builds and Validates Your API
We deliver a hardened Availity adapter tailored to your workflows and entitlements.
- Deploy with Monitoring
Go live with continuous monitoring and automatic adjustments as Availity evolves.
API Endpoints
Authentication
/sessionsEstablish a session using credentials. Supergood manages MFA (SMS, email, TOTP) and SSO/OAuth when enabled. Returns a short-lived auth token maintained by the platform.
Eligibility & Benefits
/eligibilityRetrieve member eligibility and benefits for a given payer, provider, and service date. Use this to validate coverage and surface copays/coinsurance.
Prior Authorizations
/authorizationsCreate a prior authorization request with diagnoses, procedures, service dates, facility, and rendering provider details. Supports attachment references and urgency.
Claims
/claimsAssemble and submit an 837P/I claim. Supergood normalizes service lines and can route the generated file to the configured clearinghouse channel.
Remittances (ERA)
/remittancesRetrieve ERA (835) summaries for reconciliation. Use to match payments to claims and drive denial management.
Use Cases
Coverage-Aware Scheduling and Front-Office Verification
- Verify eligibility and benefits before appointments - Surface copays, coinsurance, and deductible accumulators at check-in - Prevent out-of-network or inactive coverage scenarios before service
Prior Authorization Automation
- Submit authorization requests with diagnoses, procedures, and required attachments - Track payer responses and route follow-ups to care coordinators - Detect plan rules to avoid avoidable denials and delays
Claims Generation and Reimbursement Automation
- Bundle encounters into compliant 837P/I claims with payer-specific formatting - Submit via the configured clearinghouse channel and track 277 acknowledgments - Retrieve 835 ERA remittances and reconcile payments and adjustments
Denial Management and Revenue Cycle
- Pull claim status updates and denial reasons - Drive work queues using CARC/RARC codes from ERA - Monitor recovery, rework, and resubmission performance
Provider and Payer Connectivity
- Monitor EFT/ERA enrollment status across payers - Manage payer rosters and plan connectivity via Availity’s network - Coordinate data exchange alongside EHRs like Epic, Cerner, and athenahealth
Technical Specifications
Authentication
Username/password with MFA (SMS, email, TOTP) and SSO/OAuth where enabled; supports service accounts or customer-managed credentials
Response format
JSON with consistent resource schemas and pagination
Rate limits
Tuned for enterprise throughput while honoring licensing and usage controls
Session management
Automatic reauth and cookie/session rotation with health checks
Data freshness
Near real-time retrieval of eligibility, authorizations, claims, status, and ERA artifacts
Security
Encrypted transport, scoped tokens, and audit logging; respects Availity entitlements and compliance requirements
Webhooks
Optional asynchronous delivery for claim status changes, authorization updates, and remittance postings
Latency
Sub-second responses for list/detail queries under normal load
Throughput
Designed for high-volume EDI and batch claims pipelines
Reliability
Retry logic, backoff, and idempotency keys minimize duplicate actions
Adaptation
Continuous monitoring for UI/API changes with rapid adapter updates
Frequently asked questions
Supergood supports workflows across commonly used Availity provider portals and clearinghouse functions, subject to your licensing and entitlements. We scope coverage (e.g., eligibility/benefits, authorizations, claim submission, claim status, ERA retrieval) during integration assessment.
We support username/password + MFA (SMS, email, TOTP) and can operate behind SSO/OAuth when enabled. For EDI/batch flows, we manage timing windows, generate 837 files, and retrieve signed URLs or delivery confirmations programmatically.
Yes. You can assemble 837P/I from encounter data, submit via configured channels, track 277 acknowledgments, and pull 835 ERA remittances to drive reconciliation, denials, and follow-up.