Availity connector for AI agents

Tools your revenue cycle agent reaches for on Availity, scoped per connection.

CALL ANY TOOL

11 tools for payer transactions in Availity: send eligibility and claim status inquiries, list payers and their field rules, and search, submit, update, or void prior authorizations and referrals.

availity_claim_status_get

Get claim status

Get the full claim status response (X12 277) for one claim status ID. Returns status and statusCode, payer, submitter, providers, subscriber, patient and claimStatuses with claim control numbers, statusDetails (category, status code, claim and payment amounts, finalized and remittance dates, check number) and serviceLines. Use claim_status_get after claim_statuses_search returns an id. Use claim_statuses_search to start a new inquiry.

Parameters

Name

Type

Required

Description

claim_status_id

string

Required

The claim status ID returned by claim_statuses_search (the id field of a claimStatuses item). Example: 5334032768852043884

availity_claim_statuses_search

Search claim statuses

Send a claim status inquiry (X12 276) to a health plan through Availity for claims matching the given payer, provider, member and service dates. Returns HTTP 202 with an empty claimStatuses list while the payer is processing, then claimStatuses summaries with id, status, statusCode, claimNumber, claimAmount and dates. Use claim_statuses_search to start the inquiry and repeat the same call to poll. Use claim_status_get with a returned id for the full 277 detail, including status codes, payments and service lines. Use configurations_list with type claim-statuses-inquiry to see which fields the payer requires.

Parameters

Name

Type

Required

Description

payer_id

string

Required

Availity-specific identifier of the health plan that processed the claim, from payers_list. Example: BCBSF

claim_amount

string

Optional

Total charge amount on the claim, as a decimal string. Example: 150.00

claim_number

string

Optional

The health plan's claim tracking number assigned when the claim was received. Example: CLM0001

facility_type_code

string

Optional

Where services were performed: a place of service code for professional claims (X12 code source 237, e.g. 11 office) or a bill type for institutional claims (code source 236, e.g. 13 hospital outpatient).

frequency_type_code

string

Optional

Claim frequency type code (X12 code source 235), such as 1 (original claim) or 7 (replacement).

from_date

string

Optional

First date of service on the claim, as YYYY-MM-DD. Example: 2026-01-05

patient_account_number

string

Optional

The provider's own account or reference number for the patient, as sent on the claim. Example: ACCT-0001

patient_birth_date

string

Optional

The patient's date of birth as YYYY-MM-DD. Example: 1980-01-01

patient_first_name

string

Optional

The patient's first name. Example: SAMPLE

patient_gender_code

string

Optional

The patient's gender code: F (female) or M (male). One of: `F`, `M`.

patient_last_name

string

Optional

The patient's last name, when the patient is not the subscriber. Example: TESTPATIENT

patient_subscriber_relationship_code

string

Optional

X12 837 individual relationship code of the patient to the subscriber, such as 18 (self), 01 (spouse) or 19 (child).

payer_assigned_provider_id

string

Optional

The health plan-assigned ID of the service provider. Example: P12345

provider_first_name

string

Optional

First name of the service provider, when the provider is a person. Example: ALEX

provider_last_name

string

Optional

Last name or business name of the service provider on the claim. Example: EXAMPLE CLINIC

provider_npi

string

Optional

The service provider's 10-digit NPI. Example: 1234567893

provider_tax_id

string

Optional

The service provider's 9-digit tax ID with no dashes. Example: 123456789

submitter_first_name

string

Optional

First name of the claim submitter, when the submitter is a person. Example: ALEX

submitter_id

string

Optional

The submitter's identifier, for health plans that require it. Example: G12345

submitter_last_name

string

Optional

Last name or business name of the claim submitter. Example: EXAMPLE CLINIC

subscriber_first_name

string

Optional

The subscriber's first name. Example: SAMPLE

subscriber_last_name

string

Optional

The subscriber's last name. Example: TESTPATIENT

subscriber_member_id

string

Optional

The subscriber's health plan member ID. Example: ABC123456789

to_date

string

Optional

Last date of service on the claim, as YYYY-MM-DD. Example: 2026-01-05

availity_configurations_list

List configurations

availity_coverage_create

Create coverage

Send an eligibility and benefits inquiry (X12 270) for a patient to their health plan through Availity. Returns the coverage with its id, status and statusCode (0 In Progress, 4 Complete, other codes are errors), and once complete the payer, subscriber, patient and plans with benefits. Use coverage_create to start a check. When statusCode is 0, poll coverage_get with the returned id every few seconds until it changes. Use configurations_list with type 270 to see which fields the payer requires.

Parameters

Name

Type

Required

Description

payer_id

string

Required

Availity-specific identifier of the patient's health plan, from payers_list. Example: BCBSF

service_type

string

Required

X12 270 service type code for the benefits to check. 30 = Health Benefit Plan Coverage (general eligibility). Other common codes: 1 (Medical Care), 33 (Chiropractic), 35 (Dental Care), 47 (Hospital), 48 (Hospital Inpatient), 50 (Hospital Outpatient), 86 (Emergency Services), 88 (Pharmacy), 98 (Professional Physician Visit - Office), MH (Mental Health), UC (Urgent Care). One code per request.

as_of_date

string

Optional

Date of service to check coverage for, as YYYY-MM-DD. Defaults to today at the health plan. Example: 2026-01-15

card_issue_date

string

Optional

Issue date on the member's health plan card, as YYYY-MM-DD, for plans that require it. Example: 2025-01-01

group_number

string

Optional

The patient's health plan group number. Example: GRP12345

medicaid_id

string

Optional

The patient's Medicaid ID number, for Medicaid plans. Example: 123456789012

member_id

string

Optional

The patient's or subscriber's health plan member ID as printed on the card. Example: ABC123456789

mock_scenario_id

string

Optional

Demo plan only. ID of the canned response scenario Availity's Demo plan should return, sent as the X-Api-Mock-Scenario-ID header. Leave empty on the Standard (production) plan. Valid IDs for this operation: Coverages-Complete-i, Coverages-InProgress-i, Coverages-Retrying-i, Coverages-PayerError1-i, Coverages-PayerError2-i, Coverages-RequestError1-i, Coverages-RequestError2-i.

patient_birth_date

string

Optional

The patient's date of birth as YYYY-MM-DD. Most health plans require it. Example: 1980-01-01

patient_first_name

string

Optional

The patient's first name. Example: SAMPLE

patient_gender

string

Optional

The patient's gender code: M (male), F (female) or U (unknown). One of: `M`, `F`, `U`.

patient_last_name

string

Optional

The patient's last name. Example: TESTPATIENT

patient_middle_name

string

Optional

The patient's middle name or initial. Example: Q

patient_state

string

Optional

Two-letter code of the patient's state of residence, for plans that require it. Example: FL

patient_suffix

string

Optional

The patient's name suffix. Example: JR

payer_assigned_provider_id

string

Optional

An identifier the health plan assigned to the requesting provider, for plans that accept one. Example: P12345

place_of_service

string

Optional

Place of service code, for health plans that require it (X12 code source 237). Example: 11 (office)

procedure_code

string

Optional

Procedure code to check benefits for, such as a CPT or HCPCS code, for plans that support procedure-level inquiries. Example: 99213

provider_city

string

Optional

The requesting provider's city, for health plans that require it. Example: JACKSONVILLE

provider_first_name

string

Optional

The requesting provider's first name, when the provider is a person. Example: ALEX

provider_last_name

string

Optional

The requesting provider's last name or organization name. Example: EXAMPLE CLINIC

provider_npi

string

Optional

The requesting provider's 10-digit National Provider Identifier. Most health plans require it. Example: 1234567893

provider_specialty

string

Optional

The requesting provider's specialty as an X12 provider taxonomy code (code source 682). Example: 207Q00000X

provider_state

string

Optional

The requesting provider's two-letter state code, for health plans that require it. Example: FL

provider_tax_id

string

Optional

The requesting provider's 9-digit tax ID with no dashes, for health plans that require it. Example: 123456789

provider_zip_code

string

Optional

The requesting provider's ZIP code, for health plans that require it. Example: 32202

submitter_id

string

Optional

A payer-assigned submitter identifier, for health plans that require it. Example: G12345

subscriber_relationship

string

Optional

The patient's relationship to the subscriber when the patient is not the subscriber: 18 (self), 01 (spouse), 19 (child) or G8 (other relationship). One of: `18`, `01`, `19`, `G8`.

to_date

string

Optional

End date of the coverage period to check, as YYYY-MM-DD, for health plans that support a date range. Example: 2026-01-31

availity_coverage_get

Get coverage

availity_payers_list

List payers

availity_service_review_create

Create service review

Submit a prior authorization or referral request (X12 278) to a health plan through Availity: an outpatient authorization (HS), inpatient admission review (AR) or specialty care referral (SC). Returns HTTP 202 with the service review's id, status and statusCode, the submitted fields and any validationMessages, while Availity sends it to the payer. Use service_review_create to submit a new request, then poll service_review_get with the returned id for the payer's decision. Use configurations_list with type service-reviews and the matching subtype (HS, AR or SC) first to learn the payer's required fields.

Parameters

Name

Type

Required

Description

patient

object

Required

The patient: firstName, lastName, birthDate (YYYY-MM-DD), genderCode (M or F) and subscriberRelationshipCode (18 self, 01 spouse, 19 child, G8 other), plus address fields if the payer requires them. Example: {"firstName": "SAMPLE", "lastName": "TESTPATIENT", "birthDate": "1980-01-01", "genderCode": "F", "subscriberRelationshipCode": "18"}

payer

object

Required

The patient's health plan. Needs the Availity payer id; name is optional. Example: {"id": "BCBSF", "name": "FLORIDA BLUE"}

request_type_code

string

Required

Type of review: HS (Health Services Review, outpatient authorization), AR (Admission Review, inpatient authorization) or SC (Specialty Care Review, referral). One of: `HS`, `AR`, `SC`.

requesting_provider

object

Required

The provider requesting the authorization or referral: name (lastName for an organization, plus firstName for a person), npi, and the taxId, submitterId, specialtyCode (taxonomy), address (addressLine1, city, stateCode, zipCode) and contact (contactName, phone, fax) fields the payer requires. Field names follow Availity's Service Reviews schema. Example: {"lastName": "EXAMPLE CLINIC", "npi": "1234567893", "specialtyCode": "207Q00000X", "addressLine1": "1 MAIN ST", "city": "JACKSONVILLE", "stateCode": "FL", "zipCode": "32202", "contactName": "FRONT DESK", "phone": "5555550100"}

subscriber

object

Required

The health plan subscriber: memberId, plus firstName and lastName and any address fields the payer requires. Example: {"memberId": "ABC123456789", "firstName": "SAMPLE", "lastName": "TESTPATIENT"}

additional_fields

object

Optional

Any other Service Reviews fields the payer requires, merged into the request as-is, for example transport, oxygen, home health or chiropractic details, or providerNotes. Field names follow Availity's Service Reviews schema. Example: {"providerNotes": [{"message": "Prior conservative therapy completed"}]}

admission_source_code

string

Optional

Inpatient admissions only: admission source code, such as 1 (physician referral) or 4 (transfer from a hospital).

admission_type_code

string

Optional

Inpatient admissions only: admission type code (X12 code source 231), such as 1 (emergency), 2 (urgent) or 3 (elective).

diagnoses

array

Optional

Diagnoses supporting the request. Each item has a qualifierCode (ABK for the principal ICD-10-CM diagnosis, ABF for others) and the ICD-10 code. Example: [{"qualifierCode": "ABK", "code": "M54.50"}]

from_date

string

Optional

Service or admission start date, as YYYY-MM-DD. Example: 2026-02-01

mock_scenario_id

string

Optional

place_of_service_code

string

Optional

Place of service code (X12 code source 237 for professional, 236 for institutional). Examples: 11 (office), 21 (inpatient hospital), 22 (outpatient hospital).

procedures

array

Optional

Procedures being requested. Each item has a qualifierCode (HC for CPT/HCPCS), the procedure code, and optionally fromDate, toDate, quantity and quantityTypeCode. Example: [{"qualifierCode": "HC", "code": "72148", "quantity": "1", "quantityTypeCode": "UN"}]

quantity

string

Optional

Number of units requested, such as visits or days, as a string. Set quantity_type_code too. Example: 3

quantity_type_code

string

Optional

Code for the quantity's unit, such as DY (days) or VS (visits).

rendering_providers

array

Optional

Providers or facilities that will perform the service. Each item has a roleCode (for example SJ service provider, FA facility, 71 attending physician), name (lastName, firstName), npi, specialtyCode and address fields. Example: [{"roleCode": "SJ", "lastName": "EXAMPLE IMAGING", "npi": "1234567893", "addressLine1": "2 MAIN ST", "city": "JACKSONVILLE", "stateCode": "FL", "zipCode": "32202"}]

service_level_code

string

Optional

Level of service code, such as E (elective), U (urgent) or 03 (emergency), when the payer requires it.

service_type_code

string

Optional

X12 service type code for the service being reviewed. Examples: 1 (Medical Care), 2 (Surgical), 42 (Home Health Care), 48 (Hospital Inpatient), 69 (Maternity), 73 (Diagnostic Medical), A9 (Rehabilitation). Use configurations_list with type service-reviews for the payer's allowed values.

to_date

string

Optional

Service end date or discharge date, as YYYY-MM-DD. Example: 2026-02-03

availity_service_review_get

Get service review

availity_service_review_update

Update service review

availity_service_review_void

Void service review

availity_service_reviews_search

Search service reviews

Search a health plan's system for existing prior authorizations and referrals (X12 278 inquiry) by payer, provider, member, patient, dates or certification and reference numbers. Returns HTTP 202 while the payer is being queried, then serviceReviews with id, status, statusCode, certificationNumber or referenceNumber, requestType, serviceType and dates. Use service_reviews_search to check whether an authorization exists or to find one to update or void. Use service_review_get when you already have the id. Use configurations_list with type service-reviews-inquiry to see which search fields the payer requires.

Parameters

Name

Type

Required

Description

certification_issue_date

string

Optional

Date the authorization certification was issued, as YYYY-MM-DD. Example: 2026-02-01

certification_number

string

Optional

Number the health plan assigned once the authorization was certified. Example: 1231723

from_date

string

Optional

Service beginning date, as YYYY-MM-DD. Example: 2026-02-01

mock_scenario_id

string

Optional

Demo plan only. ID of the canned response scenario Availity's Demo plan should return, sent as the X-Api-Mock-Scenario-ID header. Leave empty on the Standard (production) plan. Valid IDs for this operation: SRI-GetComplete-i, SRI-GetAccepted-i, SRI-GetInProgress-i, SRI-GetRetrying-i, SRI-GetPayerError-i, SRI-GetPayerDown-i, SRI-GetRequestError-i.

patient_birth_date

string

Optional

The patient's date of birth as YYYY-MM-DD. Example: 1980-01-01

patient_first_name

string

Optional

The patient's first name. Example: SAMPLE

patient_last_name

string

Optional

The patient's last name. Example: TESTPATIENT

patient_subscriber_relationship_code

string

Optional

Patient's relationship to the subscriber: 18 (self), 01 (spouse), 19 (child) or G8 (other). One of: `18`, `01`, `19`, `G8`.

payer_id

string

Optional

Availity-specific identifier of the patient's health plan. Example: BCBSF

reference_number

string

Optional

Number the health plan assigned to a submitted request while under review; often called the case or authorization number. Example: REF12345

request_type_code

string

Optional

Type of review to search: HS (outpatient authorization), AR (inpatient admission review) or SC (referral). One of: `HS`, `AR`, `SC`.

requesting_provider_first_name

string

Optional

The requesting provider's first name. Example: ALEX

requesting_provider_last_name

string

Optional

The requesting provider's last or business name. Example: EXAMPLE CLINIC

requesting_provider_npi

string

Optional

The requesting provider's 10-digit NPI. Example: 1234567893

requesting_provider_specialty_code

string

Optional

The requesting provider's taxonomy code (X12 code source 682). Example: 207Q00000X

requesting_provider_submitter_id

string

Optional

The requesting provider's payer-specific submitter ID. Example: G12345

requesting_provider_tax_id

string

Optional

The requesting provider's tax ID, no dashes. Example: 123456789

session_id

string

Optional

Poll a search that is still running: pass the sessionId from the Location of an earlier 202 response (valid for 24 hours). When set, send no other search fields. Example: -1283121411

status_code

string

Optional

Only return reviews with this status code, for example A1 (Certified in Total) or A4 (Pended).

subscriber_first_name

string

Optional

The subscriber's first name. Example: SAMPLE

subscriber_last_name

string

Optional

The subscriber's last name. Example: TESTPATIENT

subscriber_member_id

string

Optional

The subscriber's health plan member ID. Example: ABC123456789

to_date

string

Optional

Service end date, as YYYY-MM-DD. Example: 2026-02-28

Build your Agent

Same auth pattern across LangChain, OpenAI, Anthropic, and Google ADK.

import { ScalekitClient } from "@scalekit-sdk/node";
import { createReactAgent } from "@langchain/langgraph/prebuilt";

const sk = new ScalekitClient(env.SCALEKIT_ENV_URL, env.SCALEKIT_CLIENT_ID, env.SCALEKIT_CLIENT_SECRET);

// Availity tools available to this agent
const { tools } = await sk.tools.listScopedTools("user_123", {
  filter: { connectionNames: ["availity"], toolNames: [
    "availity_coverage_create",
    "availity_coverage_get",
    "availity_claim_statuses_search"] },
  pageSize: 100,
});

const agent = createReactAgent({ llm, tools });
await agent.invoke({ messages: [{ role: "user", content: "Check eligibility for member W123456789 and the status of their March claims" }] });

import OpenAI from "openai";
import { ScalekitClient } from "@scalekit-sdk/node";

const sk = new ScalekitClient(env.SCALEKIT_ENV_URL, env.SCALEKIT_CLIENT_ID, env.SCALEKIT_CLIENT_SECRET);
const openai = new OpenAI();

const { tools } = await sk.tools.listScopedTools("user_123", {
  filter: { connectionNames: ["availity"] }, pageSize: 100,
});

const res = await openai.chat.completions.create({
  model: "gpt-5",
  messages: [{ role: "user", content: "Check eligibility for member W123456789 and the status of their March claims" }],
  tools,
});

// Execute the tool call with the vaulted Availity service account credentials
await sk.tools.executeTool(res.choices[0].message.tool_calls[0], "user_123");

import Anthropic from "@anthropic-ai/sdk";
import { ScalekitClient } from "@scalekit-sdk/node";

const sk = new ScalekitClient(env.SCALEKIT_ENV_URL, env.SCALEKIT_CLIENT_ID, env.SCALEKIT_CLIENT_SECRET);
const anthropic = new Anthropic();

const { tools } = await sk.tools.listScopedTools("user_123", {
  filter: { connectionNames: ["availity"] }, pageSize: 100,
});

const msg = await anthropic.messages.create({
  model: "claude-sonnet-5",
  max_tokens: 1024,
  messages: [{ role: "user", content: "Check eligibility for member W123456789 and the status of their March claims" }],
  tools,
});

// Tool call runs with the vaulted Availity service account credentials
await sk.tools.executeTool(msg.content, "user_123");

import { Agent } from "@google/adk/agents";
import { ScalekitClient } from "@scalekit-sdk/node";

const sk = new ScalekitClient(env.SCALEKIT_ENV_URL, env.SCALEKIT_CLIENT_ID, env.SCALEKIT_CLIENT_SECRET);

const { tools } = await sk.tools.listScopedTools("user_123", {
  filter: { connectionNames: ["availity"] }, pageSize: 100,
});

const agent = new Agent({
  name: "revenue_cycle_agent",
  model: "gemini-2.5-pro",
  instruction: "Availity tools available to this agent",
  tools,
});

await agent.run("Check eligibility for member W123456789 and the status of their March claims");

Try these prompts

Copy any prompt into your agent. Each maps directly to a Availity tool. Click to copy, paste into your agent, done.

Eligibility

Copy the prompt

Copied

Check eligibility and benefits for member W123456789 with this payer for today.

Copy the prompt

Copied

Get the result of the eligibility inquiry I sent this morning.

Copy the prompt

Copied

List the payers on our contract that support eligibility inquiries.

Claim status

Copy the prompt

Copied

Check the status of this member's claims with dates of service in March.

Copy the prompt

Copied

Get the full claim status response for this claim status ID.

Copy the prompt

Copied

Show the field requirements this payer has for claim status inquiries.

Prior authorizations

Copy the prompt

Copied

Search this payer for existing prior authorizations for member W123456789.

Copy the prompt

Copied

Submit an outpatient prior authorization request for this MRI to the member's health plan.

Copy the prompt

Copied

Void the referral that was sent to the wrong payer.

SEE HOW AUTH WORKS

You connect Availity once with a service account, and Scalekit authenticates every call. Credentials stay vaulted, every call is scope checked, and every action is logged.

Authorize

Your user connects

Availity

once. We tie it to their identity and the meetings they approved — no shared bot account, no org-wide access

Who:

user ‘A’

when:

Once per user

access:

Limited to user

Store

Their

Availity

token lives in a vault scoped to them. User A's meetings are never reachable by an agent acting for user B, even on the same connection

vault:

encrypted

scope:

per-user

tokens:

auto-refreshed

Resolve

When your agent calls a

Availity

tool, we fetch the right token server-side. It never touches your agent, never appears in the LLM context, never shows up in your logs

speed:

~40ms

check:

before every call

seen by:

nobody

Audit

Every

Availity

tool call is logged — who triggered it, which meeting was fetched, what came back. 90 days of history, tied to the user who authorized it

history:

90 days

export:

SIEM-ready

logged:

every call

Test other agents

See the same auth pattern across other healthcare connectors.

Support and Ops Teams

Support ticket automation agent

Fetches new Zendesk tickets, drafts a reply from Notion knowledge base articles, digests what it cannot answer to Slack, and archives the rest, acting as the support agent rather than a shared API key.

Engineering Teams

Slack triage

Polls Slack for new messages, classifies bugs and support requests with a LangGraph router, files GitHub issues or Zendesk tickets, and confirms in the thread.

Why Scalekit

Secure your agent's access. Connectors ship in minutes

01.

One service account needs a clear audit trail

Availity credentials belong to your provider organization, so every inquiry reaches the health plan under one app. Scalekit logs each tool call with the connected account and tool that ran it, so you can trace which agent run sent which transaction.

// raw client credentials
audit → ?

// scalekit
audit → account + tool ✓

02.

Authentication is not authorization

03.

Multi-tenancy is architectural

04.

Availity today. Ten connectors tomorrow.

“Our agents act across Salesforce, Gong, Google Drive, and more, on behalf of every customer. Scalekit behind the scenes meant we can keep adding tools without ever rebuilding how credentials or tool calling work.”

Venu Madhav Kattagoni

Head of Engineering / Von

FAQs

Frequently Asked Questions

Does the agent access Availity as a clinician or through a service account?

Through a service account. You connect Availity once with the client ID and secret of an app on the Availity Developer Portal, and Scalekit exchanges them for short-lived access tokens. The credentials belong to your provider organization, so tool calls act for the organization rather than an individual clinician.

Where are the Availity service account credentials stored?

In Scalekit's managed AES-256 token vault, namespaced per tenant. Revocation is a single dashboard action. Credentials never appear in prompts, logs, or LLM context.

Can I limit what the agent does in Availity?

Yes. Filter by tool name in listScopedTools to expose only what you want, for example the eligibility, claim status, and payer lookup tools without availity_service_review_create, availity_service_review_update, or availity_service_review_void, which send changes to the health plan. Scalekit also enforces scope checks before every API call.

What happens when Availity access is turned off?

Disable the connection in the Scalekit dashboard and the next tool call fails closed with a clear error. Other tenants are unaffected, and the change is logged.

Which health plans can the agent reach through Availity?

The payers available on your Availity contract. availity_payers_list returns them, filtered by payer ID, supported transaction type or submission mode, and availity_configurations_list returns a payer's field requirements and validation rules for a transaction before the agent sends it.