For all the attention FHIR gets, an enormous share of healthcare’s actual money and paperwork still moves over X12 EDI. Eligibility checks, claim status, prior authorization—these are the administrative transactions that every payer and provider runs constantly, and they are defined by numbered X12 transaction sets that predate most of the modern API conversation. Availity sits in the middle of that traffic, and its API exposes these transactions as discrete operations, which makes it a clean fit for capturing the revenue-cycle workflows as Arazzo.
The eligibility and benefits workflow is the X12 270/271 pattern: find the payer, submit the eligibility request, and read the benefits back. The claim status inquiry workflow is the 276/277 pattern, expressed honestly as an asynchronous submit-and-poll because that is how it behaves—submit the inquiry, then poll until the status reaches a real finalized state from Availity’s own schema. These are not invented sequences; they are the standard administrative round-trips that keep claims moving, written down so the steps and the wait are explicit.
The one I think matters most is prior authorization, the X12 278 transaction that is the source of so much friction in American healthcare. The workflow I captured walks the full arc: check whether an authorization is even required, get that result, create the service review, attach the supporting clinical documentation, and read the review back. There is also a claim attachment workflow for the 275 transaction. Every step references a real operationId in Availity’s spec, and the polling steps use the actual status enums rather than a generic placeholder.
Here is the front of that 278 prior authorization flow, taken straight from the repo—the auth-required determination feeding into the service review:
- stepId: checkAuthRequired
description: Submit the inquiry that determines whether the payer requires authorization for the requested services.
operationId: checkIsAuthRequired
requestBody:
contentType: application/json
payload: $inputs.authCheckRequest
successCriteria:
- condition: $statusCode == 200
outputs:
checkId: $response.body#/id
- stepId: createReview
description: Create the X12 278 service review request for the requested services.
operationId: createServiceReview
requestBody:
contentType: application/json
payload: $inputs.serviceReview
successCriteria:
- condition: $statusCode == 200
outputs:
reviewId: $response.body#/id
All four Availity workflows live in the repo at api-evangelist/availity/arazzo, including the prior authorization workflow excerpted above and the eligibility and benefits workflow.
X12 is exactly the kind of standard that benefits from being made legible. The transaction sets are real and well-defined, but the multi-step, asynchronous, attachment-laden reality of running them is usually buried in integration code. Turning eligibility, claim status, and prior authorization into reviewable Arazzo workflows is a way of taking the administrative side of healthcare as seriously as the clinical side—because that administrative side is where a lot of the cost and frustration actually lives.
