Availity

Ask the payer where a claim stands (received, pending, denied or paid) with a claim status inquiry (X12 276/277).

Get the payer’s full answer for one claim status inquiry, with paid amount, check number and line-level status.

Delete Availity’s stored copy of a claim status inquiry without changing anything at the payer.

Get a health plan’s field rules for one transaction, or the payers that support that transaction.

Ask a health plan what a patient will likely owe for physician or supplier services when there is no eligibility check f…

Get the payer answer to a professional cost estimate, including what the patient will likely owe per service line.

Ask a health plan what a patient will likely owe for hospital or facility services (Patient Cost Estimator Institutional…

Get the payer answer to a facility cost estimate, including what the patient will likely owe.

Ask a health plan what a patient will likely owe for physician services, using an eligibility check from today (Patient…

Get the payer answer to a 2.0.0 professional cost estimate, including what the patient will likely owe per service line.

Start an eligibility and benefits check (Availity Coverages) for a patient with their health plan.

Get the full eligibility and benefits answer for one coverage check.

Delete Availity’s stored copy of one eligibility and benefits answer (a coverage).

Submit a dental claim or encounter (X12 837D) to the payer for payment through Availity.

Get a submitted dental claim by id to confirm Availity has processed it.

List the health plans (payers) reachable through Availity and the transactions each one supports.

List health plans and their supported transactions from the separate AWS Availity Payer List 2.0.0 product.

Find the checks and EFT payments payers sent in a date range, from their remittance (ERA) data.

Get the full remittance for one check or EFT payment, with every claim it pays.

Find whether, when and how much a payer paid on a claim, from the payer’s remittance (ERA) data.

Get the full payment detail of one claim from the payer’s remittance.

Get the raw X12 835 remittance file for one check or EFT payment.

Submit a prior authorization or referral request (X12 278) to a health plan through Availity Service Reviews.

Get one prior authorization or referral (an Availity service review) with the payer’s decision and authorization number.

Find existing prior authorizations and referrals (Availity service reviews) at a payer by authorization number, referenc…

Change an existing prior authorization or referral (an Availity service review) at the payer, such as dates, units or pr…

Void (cancel) a prior authorization or referral (an Availity service review) at the payer.