Verify patient eligibility and benefits using the Availity Eligibility API

Steps

1. Register for Availity developer access and create an application to obtain OAuth 2.0 credentials; authenticate using client credentials flow to retrieve a bearer token (YOUR_TOKEN) scoped to eligibility transactions
2. Build the eligibility request payload specifying the payer ID (Availity's payer list maps payer names to their routing IDs), subscriber information (member ID, name, date of birth), provider NPI, and service type codes for the benefits you need to check
3. POST the request to the Availity eligibility endpoint and inspect the response status — Availity returns responses synchronously for most payers but may return a pending status for some that require a callback
4. Parse the response to extract benefit information: deductible amounts (met and remaining), out-of-pocket maximums, copay and coinsurance for the relevant service types, and any plan limitations or exclusions
5. Check the subscriber and dependent sections separately if the patient is a dependent on another member's plan; dependent eligibility details may differ from subscriber-level benefits
6. Log the transaction ID from the response for audit purposes and to support dispute resolution if eligibility information differs from actual adjudication