availity

name	availity
description	Availity Essentials — lets an agent perform real-time eligibility verification, prior authorization initiation and status checks, and payer enrollment management via the Availity clearinghouse REST API.
metadata	{"openclaw":{"requires":{"env":["AVAILITY_CLIENT_ID","AVAILITY_CLIENT_SECRET","AVAILITY_BASE_URL","AVAILITY_ORG_ID"]}},"primaryEnv":"AVAILITY_CLIENT_ID"}

Availity Essentials

What it is

Availity is the largest healthcare information network in the US, connecting providers to hundreds of payers for eligibility, benefits, and administrative transactions. Availity Essentials (the payer-agnostic portal and API layer) supports X12 270/271 eligibility transactions, X12 278 prior authorization requests and responses, payer-specific PA requirement lookups, and provider enrollment management. Agents use it to automate revenue cycle and PA workflows without manual portal navigation.

When to use this skill

• Verify a patient's insurance coverage, deductible status, and copay/coinsurance before a procedure
• Check whether a specific CPT/HCPCS code requires prior authorization for a given payer
• Submit a PA request (X12 278) and retrieve authorization number or denial with reason codes
• Check the status of a pending prior authorization
• Manage provider enrollment status and roster submissions across multiple payers

Credentials

This skill authenticates using variables declared in the metadata above. Copy ~/.openclaw/.env.example to ~/.openclaw/.env and fill in real values. Required variables:

• AVAILITY_CLIENT_ID - OAuth 2.0 client ID from Availity developer portal
• AVAILITY_CLIENT_SECRET - OAuth 2.0 client secret for token exchange
• AVAILITY_BASE_URL - API base URL (https://api.availity.com/availity/v1)
• AVAILITY_ORG_ID - Availity organization ID assigned to the provider group/health system

Key operations

• POST /eligibility-benefit-inquiry — real-time eligibility and benefits check (X12 270/271 equivalent); returns coverage, deductible, OOP max, PA required flag
• POST /authorizations — submit prior authorization request (X12 278 equivalent) with diagnosis, procedure, and clinical attachment
• GET /authorizations/{authId} — retrieve PA status (approved/denied/pending) and authorization number
• GET /payers/{payerId}/pa-requirements?cpt={code} — lookup whether PA is required for a specific CPT by payer
• GET /providers/{npi}/enrollments — list payer enrollment status by provider NPI
• POST /enrollments — submit new payer enrollment transaction

Notes

• Eligibility responses include a paRequired flag per service category; always surface this to the ordering workflow before scheduling.
• X12 denial reason codes (AAA/CA segments) are mapped to human-readable text in the response denyReasonDescription field.
• Availity sandbox (sandbox.availity.com) provides test payer simulators for development.
• Rate limit: 300 requests/min for eligibility; 60 requests/min for PA submissions.
• A signed Trading Partner Agreement with Availity is required before production API access is granted.