availity · Schema
Availity Eligibility Response

JSON Schema for an Availity healthcare eligibility and benefits response (equivalent to X12 271 transaction).
Properties

Name	Type	Description
id	string	Availity transaction identifier
controlNumber	string	Transaction control number matching the request
requestedDate	string
serviceDate	string
subscriber	object
payer	object
coverages	array
planInformation	object
View JSON Schema on GitHub
JSON Schema

{
  "$schema": "https://json-schema.org/draft/2020-12/schema",
  "$id": "https://raw.githubusercontent.com/api-evangelist/availity/refs/heads/main/json-schema/availity-eligibility-schema.json",
  "title": "Availity Eligibility Response",
  "description": "JSON Schema for an Availity healthcare eligibility and benefits response (equivalent to X12 271 transaction).",
  "type": "object",
  "required": ["id", "subscriber", "payer"],
  "properties": {
    "id": {
      "type": "string",
      "description": "Availity transaction identifier"
    },
    "controlNumber": {
      "type": "string",
      "description": "Transaction control number matching the request",
      "maxLength": 9
    },
    "requestedDate": {
      "type": "string",
      "format": "date-time"
    },
    "serviceDate": {
      "type": "string",
      "format": "date"
    },
    "subscriber": {
      "$ref": "#/$defs/SubscriberInfo"
    },
    "payer": {
      "$ref": "#/$defs/PayerInfo"
    },
    "coverages": {
      "type": "array",
      "items": {
        "$ref": "#/$defs/Coverage"
      }
    },
    "planInformation": {
      "$ref": "#/$defs/PlanInformation"
    }
  },
  "$defs": {
    "SubscriberInfo": {
      "type": "object",
      "required": ["memberId"],
      "properties": {
        "memberId": {"type": "string"},
        "firstName": {"type": "string"},
        "lastName": {"type": "string"},
        "dateOfBirth": {"type": "string", "format": "date"},
        "gender": {"type": "string", "enum": ["M", "F", "U"]},
        "groupNumber": {"type": "string"},
        "groupName": {"type": "string"}
      }
    },
    "PayerInfo": {
      "type": "object",
      "required": ["id", "name"],
      "properties": {
        "id": {"type": "string", "description": "Availity payer ID"},
        "name": {"type": "string"}
      }
    },
    "Coverage": {
      "type": "object",
      "properties": {
        "serviceTypeCodes": {
          "type": "array",
          "items": {"type": "string"},
          "description": "X12 service type codes (e.g., 30=Health Benefit Plan, 1=Medical)"
        },
        "serviceTypeNames": {
          "type": "array",
          "items": {"type": "string"}
        },
        "coverageStatus": {
          "type": "string",
          "enum": ["Active", "Inactive", "Cancelled"]
        },
        "effectiveDate": {"type": "string", "format": "date"},
        "expirationDate": {"type": "string", "format": "date"},
        "benefits": {
          "type": "array",
          "items": {"$ref": "#/$defs/Benefit"}
        }
      }
    },
    "Benefit": {
      "type": "object",
      "properties": {
        "code": {
          "type": "string",
          "description": "X12 benefit info code (e.g., 1=Active Coverage, C=Deductible, G=Co-payment)"
        },
        "name": {"type": "string"},
        "coverageLevel": {
          "type": "string",
          "enum": ["INDIVIDUAL", "FAMILY", "EMPLOYEE", "EMPLOYEE_AND_SPOUSE"]
        },
        "benefitAmount": {
          "type": "object",
          "properties": {
            "value": {"type": "number", "minimum": 0},
            "currency": {"type": "string"}
          }
        },
        "benefitPercent": {
          "type": "number",
          "minimum": 0,
          "maximum": 100
        },
        "inPlanNetworkIndicator": {
          "type": "string",
          "enum": ["Y", "N", "W"],
          "description": "Y=In-network, N=Out-of-network, W=Not applicable"
        },
        "timeQualifier": {
          "type": "string",
          "description": "Benefit period qualifier"
        }
      }
    },
    "PlanInformation": {
      "type": "object",
      "properties": {
        "planName": {"type": "string"},
        "groupName": {"type": "string"},
        "groupNumber": {"type": "string"},
        "planBeginDate": {"type": "string", "format": "date"},
        "planEndDate": {"type": "string", "format": "date"}
      }
    }
  }
}