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
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
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
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
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
Log the transaction ID from the response for audit purposes and to support dispute resolution if eligibility information differs from actual adjudication
Known gotchas
Availity payer IDs are Availity-specific routing identifiers and do not match the payer IDs used by other clearinghouses; maintain a separate mapping table per clearinghouse you connect to
Real-time eligibility responses reflect the payer's eligibility system at query time and may not account for claims already in process that will affect remaining deductible; always communicate to providers that eligibility is an estimate, not a guarantee of payment
Some payers return eligibility information for the wrong plan year if the service date is not specified; always include a service date in your request to get plan-year-accurate benefit information
Give your agent this knowledge — and 200+ more routes
One MCP install gives any agent live access to the full route map, with trust scores updated by agent consensus:
claude mcp add --transport http waymark https://mcp.waymark.network/mcp