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Python
import requests

url = 'https://api.simplex.sh/pa_submit_availity'
headers = {
    'X-API-Key': 'your_api_key_here',
    'Content-Type': 'application/json'
}
data = {
    'credential_name': 'my_availity_creds',
    'payer_id': 'bcbs_tx',
    'member_id': 'WLR482913057',
    'patient_first_name': 'Michael',
    'patient_last_name': 'Chen',
    'patient_dob': '1985-03-14',
    'relationship_to_subscriber': 'Self',
    'request_type': 'Outpatient Authorization',
    'service_type': '2 - Surgical',
    'review_type': 'Medical Services',
    'from_date': '2026-06-15',
    'to_date': '2026-09-15',
    'level_of_service': 'Elective',
    'place_of_service': '24 - Ambulatory Surgical Center',
    'diagnosis_code': 'M17.11',
    'procedure_codes': [
        {'code': '27447', 'units': '1'},
        {'code': '20611', 'units': '1'}
    ],
    'quantity': '1',
    'quantity_type': 'Visits',
    'requesting_provider_npi': '1528074691',
    'requesting_provider_address': '8700 Beverly Blvd Ste 310, Los Angeles, CA 90048',
    'facility_npi': '1396782440',
    'phone_number': '310-555-0142'
}

response = requests.post(url, headers=headers, json=data)
result = response.json()
print(f"PA created: {result['success']}")
print(f"PA ID: {result['pa_id']}")
print(f"Status: {result['status']}")
{
  "success": true,
  "pa_id": "<string>",
  "status": "submitted",
  "result_pdf": "<string>"
}

​
Pre-submission workflow

Before submitting, resolve all identifiers using the pre-submission endpoints:
  1. Verify Member — confirm the patient’s coverage is active
  2. Search Providers — resolve the requesting provider by NPI or name
  3. Search ICD Codes — resolve the diagnosis into an exact ICD-10 code
  4. Search Procedure Codes — resolve procedures into exact CPT/HCPCS codes
Submitting with unresolved or incorrect identifiers will result in a rejection. Always use the search endpoints to obtain exact values first.

Authorizations

​
X-API-Key
string
header
required

Simplex API Key

Body

application/json
​
credential_name
string
required

The name of the stored credential to authenticate with Availity.

​
payer_id
string
required

Payer identifier (e.g. "bcbs_tx", "anthem_bcbs", "cigna").

​
member_id
string
required

Patient's insurance member ID.

​
patient_first_name
string
required

Patient first name.

​
patient_last_name
string
required

Patient last name.

​
patient_dob
string<date>
required

Patient date of birth (YYYY-MM-DD).

​
request_type
string
required

Authorization request type (e.g. "Outpatient Authorization", "Inpatient Authorization").

​
service_type
string
required

Service type code and description (e.g. "2 - Surgical", "1 - Medical Care").

​
from_date
string<date>
required

Service start date (YYYY-MM-DD).

​
to_date
string<date>
required

Service end date (YYYY-MM-DD).

​
place_of_service
string
required

Place of service code and description (e.g. "24 - Ambulatory Surgical Center", "11 - Office").

​
diagnosis_code
string
required

ICD-10 diagnosis code. Obtained from the search_icd_codes endpoint.

​
procedure_codes
object[]
required

List of CPT/HCPCS procedure codes with units. Obtained from the search_procedure_codes endpoint.

​
requesting_provider_npi
string
required

NPI of the requesting provider. Obtained from the search_providers endpoint.

​
relationship_to_subscriber
enum<string>

Patient's relationship to the insurance subscriber.

Available options:
Self,
Spouse,
Child,
Other
​
review_type
string

Review type (e.g. "Medical Services").

​
level_of_service
enum<string>

Level of service urgency.

Available options:
Elective,
Urgent,
Emergency
​
quantity
string

Overall service quantity (e.g. "1").

​
quantity_type
string

Quantity type (e.g. "Visits", "Units").

​
requesting_provider_address
string

Selected practice address for the requesting provider, as returned by search_providers (e.g. "8700 Beverly Blvd Ste 310, Los Angeles, CA 90048").

​
facility_npi
string

NPI of the facility where the service will be performed.

​
phone_number
string

Contact phone number for the authorization request.

Response

200 - application/json

Submit prior auth response

​
success
boolean
required

Whether the prior authorization was created successfully.

​
pa_id
string
required

Unique identifier for the created prior authorization request.

​
status
enum<string>
required

Current status of the prior authorization.

Available options:
submitted,
approved,
pended,
denied,
cancelled
​
result_pdf
string

Signed URL to download the PA determination letter as a PDF. Link expires after 1 hour.