Availity integration

Check Eligibility

Perform Check Eligibility through Availity.

View as Markdown

availity_check_eligibility

writeavaility

Inputs

enabled
boolean
Enabled
Optional true-or-false value.
Default: true
skip_reason
expression
Skip Reason
Optional literal value or workflow expression.
password_expiration_slack_channel
text
Password Expiration Slack Channel
Optional text value.
Default: "#feed-alerts"
payer_id
expression
Payer Id
Optional literal value or workflow expression.
payer_name
expression
Payer Name
Optional literal value or workflow expression.
member_id
expressionrequired
Member Id
Required literal value or workflow expression.
patient_first_name
expressionrequired
Patient First Name
Required literal value or workflow expression.
patient_middle_name
expression
Patient Middle Name
Optional literal value or workflow expression.
patient_last_name
expressionrequired
Patient Last Name
Required literal value or workflow expression.
patient_birth_date
daterequired
Patient Birth Date
Required date in YYYY-MM-DD format.
patient_state
expression
Patient State
Optional literal value or workflow expression.
as_of_date
date
As Of Date
Optional date in YYYY-MM-DD format.
group_number
expression
Group Number
Optional literal value or workflow expression.
provider_npi
expression
Provider Npi
Optional literal value or workflow expression.
provider_last_name
expression
Provider Last Name
Optional literal value or workflow expression.
provider_tax_id
expression
Provider Tax Id
Optional literal value or workflow expression.
customer_id
text
Customer Id
Optional text value.
service_types
text
Service Types
Optional text value.
Default: "30"
service_type_mode
select
Service Type Mode
Optional selected identifier or value.
Options: Use org mapping/default (""), Explicit service types ("explicit"), All service types ("all")
procedure_codes
expression
Procedure Codes
Optional literal value or workflow expression.
subscriber_relationship
text
Subscriber Relationship
Optional text value.
Default: "18"
patient_search_option
text
Patient Search Option
Optional text value.
provider_type
text
Provider Type
Optional text value.
place_of_service
text
Place Of Service
Optional text value.
extra_form_fields
json
Extra Form Fields
Optional JSON value.
field_label_overrides
json
Field Label Overrides
Optional JSON value.
insurance_policy_id
expression
Insurance Policy Id
Optional literal value or workflow expression.
source_document_id
expression
Source Document Id
Optional literal value or workflow expression.
use_org_mapping
boolean
Use Org Mapping
Optional true-or-false value.
Default: true
include_linked_coverage_response_messages
boolean
Include Linked Coverage Response Messages
Optional true-or-false value.
Default: false

Outputs

successSuccess
skippedSkipped
coverage_idCoverage Id
status_codeStatus Code
statusStatus
has_active_coverageHas Active Coverage
has_coverage_determinationHas Coverage Determination
requested_procedure_codesRequested Procedure Codes
submitted_procedure_codesSubmitted Procedure Codes
procedure_code_supportProcedure Code Support
procedure_code_support_detailProcedure Code Support Detail
subscriberSubscriber
patientPatient
payerPayer
requesting_providerRequesting Provider
plansPlans
raw_responseRaw Response
customer_messageCustomer Message
payer_rejection_reasonPayer Rejection Reason
payer_rejection_categoryPayer Rejection Category
is_coverage_data_issueIs Coverage Data Issue
errorError
error_messageError Message

Output schema completeness: best_effort_declared

Safety

External effect: write
Confirmation recommended: No
Retry safe: No
Dry run supported: No

Schemas

These schemas are first-pass authoring guidance. Runtime validation remains authoritative.

Input schema

{
  "type": "object",
  "required": [
    "member_id",
    "patient_first_name",
    "patient_last_name",
    "patient_birth_date"
  ],
  "properties": {
    "enabled": {
      "type": "boolean",
      "default": true,
      "description": "Optional true-or-false value.",
      "x-workflow-field-type": "boolean"
    },
    "payer_id": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "member_id": {
      "description": "Required literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "as_of_date": {
      "type": "string",
      "format": "date",
      "description": "Optional date in YYYY-MM-DD format.",
      "x-workflow-field-type": "date"
    },
    "payer_name": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "customer_id": {
      "type": "string",
      "description": "Optional text value.",
      "x-workflow-field-type": "text"
    },
    "skip_reason": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "group_number": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "provider_npi": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "patient_state": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "provider_type": {
      "type": "string",
      "description": "Optional text value.",
      "x-workflow-field-type": "text"
    },
    "service_types": {
      "type": "string",
      "default": "30",
      "description": "Optional text value.",
      "x-workflow-field-type": "text"
    },
    "procedure_codes": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "provider_tax_id": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "use_org_mapping": {
      "type": "boolean",
      "default": true,
      "description": "Optional true-or-false value.",
      "x-workflow-field-type": "boolean"
    },
    "place_of_service": {
      "type": "string",
      "description": "Optional text value.",
      "x-workflow-field-type": "text"
    },
    "extra_form_fields": {
      "description": "Optional JSON value.",
      "x-workflow-field-type": "json"
    },
    "patient_last_name": {
      "description": "Required literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "service_type_mode": {
      "enum": [
        "",
        "explicit",
        "all"
      ],
      "type": "string",
      "description": "Optional selected identifier or value.",
      "x-workflow-field-type": "select"
    },
    "patient_birth_date": {
      "type": "string",
      "format": "date",
      "description": "Required date in YYYY-MM-DD format.",
      "x-workflow-field-type": "date"
    },
    "patient_first_name": {
      "description": "Required literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "provider_last_name": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "source_document_id": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "insurance_policy_id": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "patient_middle_name": {
      "description": "Optional literal value or workflow expression.",
      "x-workflow-field-type": "expression"
    },
    "field_label_overrides": {
      "description": "Optional JSON value.",
      "x-workflow-field-type": "json"
    },
    "patient_search_option": {
      "type": "string",
      "description": "Optional text value.",
      "x-workflow-field-type": "text"
    },
    "subscriber_relationship": {
      "type": "string",
      "default": "18",
      "description": "Optional text value.",
      "x-workflow-field-type": "text"
    },
    "password_expiration_slack_channel": {
      "type": "string",
      "default": "#feed-alerts",
      "description": "Optional text value.",
      "x-workflow-field-type": "text"
    },
    "include_linked_coverage_response_messages": {
      "type": "boolean",
      "default": false,
      "description": "Optional true-or-false value.",
      "x-workflow-field-type": "boolean"
    }
  },
  "additionalProperties": false
}

Output schema

{
  "type": "object",
  "properties": {
    "error": {},
    "payer": {},
    "plans": {},
    "status": {},
    "patient": {},
    "skipped": {},
    "success": {},
    "subscriber": {},
    "coverage_id": {},
    "status_code": {},
    "raw_response": {},
    "error_message": {},
    "customer_message": {},
    "has_active_coverage": {},
    "requesting_provider": {},
    "is_coverage_data_issue": {},
    "payer_rejection_reason": {},
    "procedure_code_support": {},
    "payer_rejection_category": {},
    "requested_procedure_codes": {},
    "submitted_procedure_codes": {},
    "has_coverage_determination": {},
    "procedure_code_support_detail": {}
  },
  "additionalProperties": true
}

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