Availity

Supergood | Availity API

Alex Klarfeld

Alex Klarfeld

— 6 min read
Supergood | Availity API

Programmatically access eligibility and benefits, prior authorizations, claims submission, claim status, and ERA remittance workflows in Availity with a stable REST API. Supergood builds and operates production-grade, unofficial Availity integrations so your team can automate critical billing and practice management pipelines without heavy custom engineering.

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 authorization requests, assemble and send 837P/I claims, retrieve 835 ERA remittances, and coordinate payer-specific workflows end to end.

If you’re a healthcare tech startup focused on billing, practice management, or provider services, integrating your tech stack with Availity unlocks concrete data flows and features:

  • Pull: Eligibility and benefit responses, payer directories, claim statuses (277), ERA remittances (835), authorization statuses, attachment requirements
  • Push: Patient/subscriber demographics, scheduled services and encounter data, prior authorization requests with clinical documentation, professional/institutional claims, claim attachments
  • Build: Coverage-aware scheduling, real-time authorization checks, automatic 837P/I generation, denial management dashboards powered by ERA and 277 data, payer enrollment status monitoring

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

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

Available Endpoints

Authentication

POST /sessions: Establish 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.

curl --request POST \
  --url https://api.supergood.ai/integrations/<integration_id>/sessions \
  --header 'Authorization: Basic <Base64 encoded token>' \
  --header 'Content-Type: application/json' \
  --data '{
    "username": "[email protected]",
    "password": "<password>",
    "mfa": {"type": "totp", "code": "123456"}
  }'

Example response

{
  "authToken": "eyJhbGciOi...",
  "expiresIn": 3600,
  "user": {
    "id": "u_81d2fa",
    "name": "Billing Admin",
    "entitlements": ["eligibility", "authorizations", "claims", "remittances"]
  }
}

Eligibility & Benefits

GET /eligibility: Retrieve member eligibility and benefits for a given payer, provider, and service date. Use this to validate coverage and surface copays/coinsurance.

Query parameters

  • memberId: string
  • memberDob: ISO 8601 date (YYYY-MM-DD)
  • memberLastName: string
  • payerId: string
  • providerNpi: string
  • serviceDate: ISO 8601 date
  • serviceTypeCode: string (optional; e.g., "30" for health benefit plan coverage)

Example response

{
  "request": {
    "memberId": "A123456789",
    "memberDob": "1985-07-14",
    "memberLastName": "Garcia",
    "payerId": "payer_availity_bcbsfl",
    "providerNpi": "1234567890",
    "serviceDate": "2026-01-20"
  },
  "eligibilityStatus": "active",
  "plan": {
    "name": "Blue Options PPO",
    "groupNumber": "GRP-99812",
    "effectiveDate": "2025-01-01",
    "terminationDate": null
  },
  "benefits": [
    {"category": "Primary Care", "copayAmount": 25.00, "coinsurancePercent": 0, "limit": null},
    {"category": "Specialist Visit", "copayAmount": 50.00, "coinsurancePercent": 0, "limit": null},
    {"category": "Emergency Room", "copayAmount": 200.00, "coinsurancePercent": 0.2, "limit": null}
  ],
  "accumulators": {
    "deductible": {"inNetworkRemaining": 350.00, "outOfNetworkRemaining": 1200.00},
    "outOfPocket": {"inNetworkRemaining": 1500.00, "outOfNetworkRemaining": 3000.00}
  }
}

Prior Authorizations

POST /authorizations: Create a prior authorization request with diagnoses, procedures, service dates, facility, and rendering provider details. Supports attachment references and urgency.

curl --request POST \
  --url https://api.supergood.ai/integrations/<integration_id>/authorizations \
  --header 'Authorization: Bearer <authToken>' \
  --header 'Content-Type: application/json' \
  --data '{
    "memberId": "A123456789",
    "payerId": "payer_availity_bcbsfl",
    "diagnosisCodes": ["M17.11", "E66.9"],
    "procedures": [
      {"cptCode": "27447", "modifiers": ["LT"], "units": 1}
    ],
    "service": {
      "startDate": "2026-02-01",
      "endDate": "2026-03-01",
      "placeOfService": "21"
    },
    "renderingProvider": {"npi": "1234567890", "taxonomy": "207X00000X"},
    "facility": {"npi": "1098765432", "name": "Sunrise Orthopedics"},
    "attachments": [{"attachmentId": "att_51f2c9", "type": "clinical_notes"}],
    "urgency": "standard",
    "referenceId": "ehr-order-99201"
  }'

Example response

{
  "authorizationId": "auth_2c74d1",
  "trackingNumber": "PA-2026-0041287",
  "status": "submitted",
  "requiredItems": [],
  "createdAt": "2026-01-20T18:22:11Z",
  "referenceId": "ehr-order-99201"
}

Claims

POST /claims: Assemble and submit an 837P/I claim. Supergood normalizes service lines and can route the generated file to the configured clearinghouse channel.

curl --request POST \
  --url https://api.supergood.ai/integrations/<integration_id>/claims \
  --header 'Authorization: Bearer <authToken>' \
  --header 'Content-Type: application/json' \
  --data '{
    "claimType": "837P",
    "payerId": "payer_availity_bcbsfl",
    "billingProvider": {
      "npi": "1234567890",
      "name": "Sunrise Orthopedics",
      "taxonomy": "207X00000X",
      "billingAddress": {
        "line1": "100 Care Way",
        "city": "Jacksonville",
        "region": "FL",
        "postalCode": "32204"
      }
    },
    "renderingProvider": {"npi": "1234567890"},
    "subscriber": {
      "memberId": "A123456789",
      "lastName": "Garcia",
      "firstName": "Ava",
      "dob": "1985-07-14"
    },
    "diagnoses": ["M17.11", "E66.9"],
    "serviceLines": [
      {"cptCode": "99213", "modifiers": [], "units": 1, "chargeAmount": 150.00, "placeOfService": "11"},
      {"cptCode": "73564", "modifiers": [], "units": 1, "chargeAmount": 95.00, "placeOfService": "11"}
    ],
    "submissionChannel": "clearinghouse",
    "referenceId": "claim-batch-jan20"
  }'

Example response

{
  "claimId": "clm_7ab2f9",
  "status": "queued",
  "edi": {"format": "837P", "size": 42317},
  "submissionChannel": "clearinghouse",
  "createdAt": "2026-01-20T19:05:42Z",
  "ack": {"type": "277", "state": "pending"},
  "referenceId": "claim-batch-jan20"
}

Remittances (ERA)

GET /remittances: Retrieve ERA (835) summaries for reconciliation. Use to match payments to claims and drive denial management.

Query parameters

  • payerId: string
  • paymentDateFrom: ISO 8601 date
  • paymentDateTo: ISO 8601 date
  • checkNumber: string (optional)

Example response

{
  "items": [
    {
      "eraId": "era_51c8aa",
      "payerId": "payer_availity_bcbsfl",
      "paymentDate": "2026-01-22",
      "paymentMethod": "EFT",
      "eftTrace": "EFT-992101",
      "totalPayment": 892.43,
      "claimPayments": [
        {
          "claimId": "clm_7ab2f9",
          "patientName": "Ava Garcia",
          "billedAmount": 245.00,
          "paidAmount": 196.00,
          "adjustments": [
            {"carc": "45", "amount": 49.00, "description": "Charge exceeds fee schedule"}
          ],
          "remarkCodes": ["N544"]
        }
      ]
    }
  ],
  "page": 1,
  "pageSize": 50,
  "total": 1
}

Get full API Specs →

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

Performance Characteristics

  • 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

Getting Started

  1. Schedule Integration Assessment

Book a 30-minute session to confirm your Availity product mix, licensing, and authentication model.

  1. Supergood Builds and Validates Your API

We deliver a hardened Availity adapter tailored to your workflows and entitlements.

  1. Deploy with Monitoring

Go live with continuous monitoring and automatic adjustments as Availity evolves.

Schedule Integration Call →

Frequently Asked Questions

Q: Which Availity products can this integration cover?

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.

Q: How are MFA, SSO, and batch interfaces handled for automation?

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.

Q: Can I generate claims and reconcile payments end-to-end?

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.

Ready to automate your Availity workflows?

Supergood can have your Availity integration live in days with no ongoing engineering maintenance.

Get Started →

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