Availity Fetch appeals

POSThttps://preview.ontross.com/api/integrations/availity/fetch-appeals

input.payer

string

Payer name exactly as Availity's payer list spells it.

Example

"HUMANA"

input.org_name

string

Organization name as Availity registers it, but the submitting provider's organization for attachments.

Example

"Lakeview Family Health"

input.limit

integer

How many appeals one page returns, 25 when omitted.

Example

25

input.offset

integer

Zero-based position of the first appeal in the page.

Example

0

input.status

string

Appeal workflow state sent as the summary request filter.

Example

"FINALIZED"

auth_id

string

required

Saved connection to run this operation through, from the Authentication page. It decides which practice and login the call uses.

Example

"00000000-0000-4000-8000-000000000000"

appeals

array

One entry per appeal matching your filters.

appeals[].id

string

Returned case identifier sent with both attachment download requests.

Example

"a63a2814-1ab3-4ea4-b526-bb8b6a0eaa34"

appeals[].payerId

string

Availity payer code the claim or appeal went to.

Example

"HUMANA"

appeals[].type

string

Kind of appeal record this is.

Example

"APPEAL"

appeals[].assignedTo

string

Availity user currently handling the appeal.

Example

"appeals.coordinator"

appeals[].createdOn

string

When the appeal was first opened.

Example

"2025-03-10T09:15:00.000Z"

appeals[].lastTouchedBy

string

Who last changed the appeal.

Example

"appeals.reviewer"

appeals[].lastTouchedOn

string

When the appeal was last changed.

Example

"2025-03-18T14:32:10.000Z"

appeals[].data

object

The appeal's claim, patient, and remittance details.

appeals[].data.externalId

string

Appeal id in the payer's own system.

Example

"APL2025031800472"

appeals[].data.caseNumber

string

Payer's case number for the appeal.

Example

"CASE2025000472"

appeals[].data.claimNumber

string

Payer's control number for the claim under review.

Example

"250770000472"

appeals[].data.patientFirstName

string

Patient's given name as the payer has it.

Example

"Avery"

appeals[].data.patientLastName

string

Patient's family name as the payer has it.

Example

"Exampleton"

appeals[].data.patientDOB

string

Patient's date of birth on the appeal.

Example

"1984-06-15"

appeals[].data.patientGender

string

Sex recorded for the patient.

Example

"F"

appeals[].data.patientAccountNumber

string

Your own account number for the patient.

Example

"PT-EXAMPLE-00472"

appeals[].data.serviceStart

string

First date of service under appeal.

Example

"2025-02-10"

appeals[].data.serviceEnd

string

Last date of service under appeal.

Example

"2025-02-12"

appeals[].data.providerName

string

Billing provider's last name or organization name only.

Example

"Cedar Lantern Family Clinic"

appeals[].data.patientId

string

Payer's internal id for the patient.

Example

"PAT-EXAMPLE-00472"

appeals[].data.attachments

array

Documents filed with the appeal, one entry each.

appeals[].data.attachments[].dcn

string

Payer's document control number, needed to download the file.

Example

"202503180000472"

appeals[].data.attachments[].documentName

string

Title the payer shows for this document.

Example

"medical_records.pdf"

appeals[].data.attachments[].documentType

string

What kind of document it is, such as medical records.

Example

"application/pdf"

appeals[].data.attachments[].documentSize

integer

File size in bytes.

Example

248576

appeals[].data.attachments[].filename

string

Name of the stored file, often different from documentName.

Example

"appeal_supporting_records.pdf"

appeals[].data.attachments[].mimeType

string

Content type of the attachment file.

Example

"application/pdf"

appeals[].data.attachments[].akaName

string

Alternate name Availity records for the document or status.

Example

"Supporting medical records"

appeals[].data.attachments[].reference

string

Availity reference pointing at the stored document.

Example

"6c713e84-f99c-48ca-80bd-3f45479c3d28"

appeals[].data.attachments[].s3Reference

string

Availity storage key for the attachment file.

Example

"appeals/attachments/6c713e84-f99c-48ca-80bd-3f45479c3d28.pdf"

appeals[].data.attachments[].createDate

string

When the attachment was filed.

Example

"2025-03-18T14:32:10.000Z"

appeals[].data.attachments[].additionalProperties

object

Extra attachment fields Availity returned without a defined slot.

appeals[].data.attachments[].ayden_file_id

string

Ayden's id for the downloaded copy of this attachment.

Example

"82fc4c9b-1618-44d7-9929-43fe7e2f5b80"

appeals[].data.relatedAppeals

array

Other appeals the payer links to this one.

appeals[].data.labels

array

Tags Availity users applied to the appeal.

appeals[].data.metadata

object

Appeal submission details, mostly payer specific fields.

appeals[].data.metadata.msg

string

Message the payer returned about the appeal.

Example

"Appeal review completed."

appeals[].data.metadata.reason

string

Payer's reason text for the appeal outcome.

Example

"Additional documentation supports the requested payment."

appeals[].data.metadata.values

string

Payer supplied values attached to the appeal.

Example

"Additional medical records received"

appeals[].data.metadata.MaTxnId

string

Payer's transaction id for the appeal submission.

Example

"d78eb0ac-b853-45f4-a9cc-40fd7521175b"

appeals[].data.metadata.onBehalfOf

string

Who the appeal was submitted for.

Example

"PROVIDER"

appeals[].data.metadata.referenceId

string

Reference the payer gave for the appeal submission.

Example

"APL2025031800472"

appeals[].data.metadata.requestType

string

Kind of appeal or dispute submitted.

Example

"APPEAL"

appeals[].data.metadata.sccfNumber

string

Payer's SCCF tracking number for the appeal.

Example

"20250770000472"

appeals[].data.metadata.locationCode

string

Payer location code routing the appeal.

Example

"01"

appeals[].data.metadata.admissionDate

string

Inpatient admission date given on the appeal.

Example

"2025-02-10"

appeals[].data.metadata.conditionCode

string

UB-04 condition code supplied with the appeal.

Example

"02"

appeals[].data.metadata.conditionDate

string

Date tied to the submitted condition code.

Example

"2025-02-10"

appeals[].data.metadata.contactNumber

string

Phone number the submitter gave for follow-up.

Example

"2025550147"

appeals[].data.metadata.submitterType

string

Whether a provider, facility, or billing service submitted it.

Example

"PROVIDER"

appeals[].data.metadata.diagnosisCodes

string

ICD codes on the line, or one joined string on appeals.

Example

"M54.50"

appeals[].data.metadata.sanctionAmount

string

Penalty amount the payer applied.

Example

"125.00"

appeals[].data.metadata.businessChannel

string

Availity channel the appeal came through.

Example

"PORTAL"

appeals[].data.metadata.attachmentMessage

string

Note the submitter attached about the documents.

Example

"Operative report and discharge summary attached."

appeals[].data.metadata.locationCodeDescription

string

Plain wording for that location code.

Example

"Main office"

appeals[].data.metadata.eligibleForClaimHistorySSO

string

Whether claim history opens by single sign-on from here.

Example

"true"

appeals[].data.metadata.submitOnBehalfOfDescription

string

Readable name of the party the appeal was filed for.

Example

"Billing provider"

appeals[].data.metadata.occurrences

string

UB-04 occurrence codes and dates sent with the appeal.

Example

"11"

appeals[].data.checkNumber

string

Identifier on the payer's check or EFT.

Example

"EFT2025031700472"

appeals[].data.checkDate

string

Date the payer issued the payment.

Example

"2025-03-17"

appeals[].data.checkAmount

number

Amount on the payment check or EFT.

Example

842.75

appeals[].data.totalBilled

number

Total charge across the appealed claim.

Example

1250

appeals[].data.totalPaid

number

Total the payer paid across the appealed claim.

Example

842.75

appeals[].data.methodOfReceipt

string

How the payer received the appeal, such as portal.

Example

"PORTAL"

appeals[].data.lineOfBusiness

string

Plan family the claim falls under, like commercial or Medicare.

Example

"MEDICARE"

appeals[].data.groupNumber

string

Policy number the member is covered under.

Example

"GRP-EXAMPLE-00472"

appeals[].status

object

Returned workflow record describing the appeal's current progress.

appeals[].status.id

string

Returned identifier for this appeal's workflow state record.

Example

"e84245d9-1d90-4df0-b23c-dfc3bab1860a"

appeals[].status.appealId

string

Appeal this status record belongs to.

Example

"a63a2814-1ab3-4ea4-b526-bb8b6a0eaa34"

appeals[].status.assignedTo

string

Availity user currently handling the appeal.

Example

"appeals.coordinator"

appeals[].status.state

string

Full state name or two-letter code, setting the region before payer lookup.

Example

"FINALIZED"

appeals[].status.substatus

string

Finer status under the appeal's main state.

Example

"COMPLETED"

appeals[].status.createDt

string

When this appeal status was recorded.

Example

"2025-03-18T14:32:10.000Z"

appeals[].status.akaName

string

Alternate name Availity records for the document or status.

Example

"Finalized"

appeals[].status.decision

string

How the payer ruled, for example upheld or overturned.

Example

"OVERTURNED"

appeals[].status.decisionReason

string

Why the payer ruled the way it did.

Example

"Medical necessity established by submitted documentation."

appeals[].status.metadata

object

Appeal submission details, mostly payer specific fields.

appeals[].npi

string

National provider identifier the appeal was filed under.

Example

"1999999999"

appeals[].customerId

string

Availity customer account that owns the appeal.

Example

"9999900472"

appeals[].lastSeen

string

When someone last viewed the appeal.

Example

"2025-03-19T08:05:22.000Z"

appeals[].errorDetails

array

Problems Availity hit loading this appeal.

total_appeals_count

integer

How many appeals the run found before downloading.

Example

10

downloaded_files_count

integer

How many attachments this run actually downloaded.

Example

14

curl --request POST \
  --url https://preview.ontross.com/api/integrations/availity/fetch-appeals \
  --header 'X-API-Key: REPLACE_KEY_VALUE' \
  --header 'content-type: application/json' \
  --data '{"input":{"payer":"HUMANA","org_name":"Lakeview Family Health","limit":25,"offset":0,"status":"FINALIZED"},"auth_id":"auth_uuid_here"}'

Request BODY

{
  "input": {
    "payer": "HUMANA",
    "org_name": "Lakeview Family Health",
    "limit": 25,
    "offset": 0,
    "status": "FINALIZED"
  },
  "auth_id": "auth_uuid_here"
}

Response BODY

{
  "id": "string",
  "workflow_id": "string",
  "auth_id": "string",
  "status": "string",
  "input": {},
  "output": {
    "appeals": [],
    "total_appeals_count": 10,
    "downloaded_files_count": 14
  },
  "files": null,
  "created_at": "2019-08-24T14:15:22Z",
  "started_at": "2019-08-24T14:15:22Z",
  "completed_at": "2019-08-24T14:15:22Z"
}