{"info":{"_postman_id":"6ceb8797-50ff-42fd-98a3-64beefaa6c94","name":"pVerify API Documentation","description":"

Updated 03/01/2026

pVerify's Real-Time Exchange System facilitates the secure exchange of health care Eligibility and related transactions, supporting one-to-one real-time transactions. One-to-one real-time transactions require customers to post a request, via REST to a designated URL address. Once a request is received by the Service an immediate response is sent for each request posted. Note that first a token must be generated using Oauth2.

The production URL is api.pverify.com

For example, the token call is: https://api.pverify.com/Token

The EligibilitySummary call is: https://api.pverify.com/API/EligibilitySummary

We now have NuGet packages for .NET coding. Download from Visual Studio today from NuGet - pVerify.Apis

Click here to download the NuGet package from GitHub.

Click here to download a sample project showing the use of the Nuget package. (C#)

Available Endpoints

Authentication

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Service	Endpoint	HTTP Method	Description
Authentication	/Token	POST	Obtain authorization to pVerify REST API.

Eligibility

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Service	Endpoint	HTTP Method	Description
	1 Step \"Easy\" Methods
Eligibility	/API/EasyEligibility	POST	Returns the Eligibility Status of a requested provider in just one step (no Token needed).
Eligibility	/API/EasyEligibilitySummary	POST	Returns the Eligibility Summary of a request in just one step (no Token needed).
	Our 2nd Generation Methods
Eligibility	/API/EligibilitySummary	POST	We recommend this for most businesses, and will work for 95% of payers. This will populate all eligibility data into discrete data objects for easy consumption, including different Medicare objects, payer change object, copays for different service types (ex: labs, specialist, chiro)
	Our 1st Generation Methods
Eligibility	/API/EligibilityInquiry	POST	Returns Status, Plan Info, Payer Change and other Eligibility Information for major payers.
Eligibility	/API/GetEligibilityResponse/{id}	GET	Get Eligibility result by unique transaction id.
	Our Backoffice Workflow
Eligibility	/API/EligibilitySummary	POST	We can accommodate non EDI payers by first submitting information via POST, then retrieving after 24 hours via GET.
Eligibility	/API/GetEligibilitySummary	GET	Returns Response from Eligibility Summary.
Eligibility	/API/CancelTransaction	POST	Cancels a back office request.
Eligibility	/API/GetPendingInquiries	GET	Get inquiries that are still being processed by pVerify back office.

Estimates

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Service	Endpoint	HTTP Method	Description
Eligibility	/API/EstimateCalculation	POST	Returns fee estimate from Medicare given Zip code, CPT code, and other info.

Same or Similar

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Service	Endpoint	HTTP Method	Description
Same or Similar	/API/SameOrSimilarInquiry	POST	Runs Same or Similar inquiry endpoint.
Same or Similar	/API/GetSameOrSimilarResponse	GET	Gets the transaction result from SorS later using unique request id.

Skilled Nursing Facility

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Service	Endpoint	HTTP Method	Description
Skilled Nursing Facility	/API/SNFInquiry	POST	Skilled Nursing Facility Inquiry
Skilled Nursing Facility	/API/GETSNFResponse	GET	Returns SNF Response from SNFInquiry

Claim Status

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Service	Endpoint	HTTP Method	Description
Claim Status	/API/ClaimStatusInquiry	POST	Obtain claim status information using subscriber demographic information
Claim Status	/API/GetClaimStatusResponse	GET	Used to obtain claim status transaction result later.

CGX

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Service	Endpoint	HTTP Method	Description
CGX	/API/CGXInquiry	POST	Run CGX Inquiry.
CGX	/WidgetSetup	POST	create widget

CMN

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Service	Endpoint	HTTP Method	Description
CMN	/API/CMNInquiry	POST	Runs CMN inquiry endpoint.
CMN	/API/GetCMNResponse	GET	Gets the transaction result from CMN later using unique request id.

Payers

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Service	Endpoint	HTTP Method	Description
Payers	/API/GetAllPayers	GET	Get pVerify payer list.
Payers	/API/GetPayerStatus	GET	Gets payer status.

Medicare HCPCS codes

For the EligibilityInquiry, GetEligibilityResponse, and EligibilitySummary calls, we can return Medicare preventative service information. You can either populate the preventative service codes in the request or as a one time set up, use our portal at Premium.Pverify.com -> Admin/Profile -> Settings -> Medicare HCPCS Codes. These settings in the UI will be used if the request HCPCS codes are blank.

For example you can add this to the request:

\"HCPCSCodes\": [\n\"G0297\"\n],\n\n

And it will return the code to the right under ServiceTypeDetailInfo - for this patient they were eligible for this code on 2/5/2015.

EligibilityInquiry Response

\"ServicesTypes\": [{\n        \"ServiceTypeName\": \"Preventive Services\",\n        \"ServiceTypeSections\": [{\n            \"Label\": \"HCPCS|G0104\",\n            \"ServiceParameters\": [{\n                \"Key\": \"Professional Eligible Date\",\n                \"Value\": \"04/01/2014\",\n                \"Message\": null,\n                \"OtherInfo\": null\n            }, {\n                \"Key\": \"Technical Eligible Date\",\n                \"Value\": \"04/01/2014\",\n                \"Message\": null,\n                \"OtherInfo\": null\n            }, {\n                \"Key\": \"Visit Co-Insurance\",\n                \"Value\": \"0%\",\n                \"Message\": null,\n                \"OtherInfo\": null\n            }, {\n                \"Key\": \"Calendar Year Deductible\",\n                \"Value\": \"$0.00\",\n                \"Message\": null,\n                \"OtherInfo\": null\n            }]\n        }, {\n            \"Label\": \"HCPCS|G0105\",\n            \"ServiceParameters\": [{\n                \"Key\": \"Professional Eligible Date\",\n                \"Value\": \"04/01/2014\",\n                \"Message\": null,\n                \"OtherInfo\": null\n            }, {\n                \"Key\": \"Technical Eligible Date\",\n                \"Value\": \"04/01/2014\",\n                \"Message\": null,\n                \"OtherInfo\": null\n            }, {\n                \"Key\": \"Visit Co-Insurance\",\n                \"Value\": \"0%\",\n                \"Message\": null,\n                \"OtherInfo\": null\n            }, {\n                \"Key\": \"Calendar Year Deductible\",\n                \"Value\": \"$0.00\",\n                \"Message\": null,\n                \"OtherInfo\": null\n            }]\n        }, {\n            \"Label\": \"HCPCS|G0106\",\n            \"ServiceParameters\": [{\n                \"Key\": \"Professional Eligible Date\",\n                \"Value\": \"04/01/2014\",\n                \"Message\": null,\n                \"OtherInfo\": null\n            }, {\n                \"Key\": \"Technical Eligible Date\",\n                \"Value\": \"04/01/2014\",\n                \"Message\": null,\n                \"OtherInfo\": null\n            }, {\n                \"Key\": \"Calendar Year Deductible\",\n                \"Value\": \"$0.00\",\n                \"Message\": null,\n                \"OtherInfo\": null\n            }]\n        }, {\n            \"Label\": \"HCPCS|G0120\",\n            \"ServiceParameters\": [{\n                \"Key\": \"Professional Eligible Date\",\n                \"Value\": \"04/01/2014\",\n                \"Message\": null,\n                \"OtherInfo\": null\n            }, {\n                \"Key\": \"Technical Eligible Date\",\n                \"Value\": \"04/01/2014\",\n                \"Message\": null,\n                \"OtherInfo\": null\n            }, {\n                \"Key\": \"Calendar Year Deductible\",\n                \"Value\": \"$0.00\",\n                \"Message\": null,\n                \"OtherInfo\": null\n            }]\n        }, {\n            \"Label\": \"HCPCS|G0121\",\n            \"ServiceParameters\": [{\n                \"Key\": \"Professional Eligible Date\",\n                \"Value\": \"04/01/2014\",\n                \"Message\": null,\n                \"OtherInfo\": null\n            }, {\n                \"Key\": \"Technical Eligible Date\",\n                \"Value\": \"04/01/2014\",\n                \"Message\": null,\n                \"OtherInfo\": null\n            }, {\n                \"Key\": \"Visit Co-Insurance\",\n                \"Value\": \"0%\",\n                \"Message\": null,\n                \"OtherInfo\": null\n            }, {\n                \"Key\": \"Calendar Year Deductible\",\n                \"Value\": \"$0.00\",\n                \"Message\": null,\n                \"OtherInfo\": null\n            }]\n        }, {\n            \"Label\": \"HCPCS|81528\",\n            \"ServiceParameters\": [{\n                \"Key\": \"Technical Eligible Date\",\n                \"Value\": \"10/09/2014\",\n                \"Message\": null,\n                \"OtherInfo\": null\n            }, {\n                \"Key\": \"Visit Co-Insurance\",\n                \"Value\": \"0%\",\n                \"Message\": null,\n                \"OtherInfo\": null\n            }, {\n                \"Key\": \"Calendar Year Deductible\",\n                \"Value\": \"$0.00\",\n                \"Message\": null,\n                \"OtherInfo\": null\n            }]\n        }]\n    }\n\n

EligibilitySummary Response

\"PreventiveServices\": [{\n    \"ProcedureCode\": \"HCPCS|G0444\",\n    \"ProcedureName\": \"Annual Depression Screening\",\n    \"TechnicalEligibleDate\": \"10/14/2011\",\n    \"ProfessionalEligibleDate\": \"10/14/2011\",\n    \"Benefits\": [{\n        \"EligibilityOrBenefit\": \"Deductible\",\n        \"InsuranceType\": \"Medicare Part B\",\n        \"Date\": [{\n            \"Date\": \"01/18/2021\",\n            \"Type\": \"Benefit\"\n        }],\n        \"TimePeriodQualifier\": \"Calendar Year\",\n        \"MonetaryAmount\": \"$0.00\",\n        \"Percent\": null,\n        \"UsedDate\": null,\n        \"IdentificationCode\": null,\n        \"IdentificationType\": null\n    }, {\n        \"EligibilityOrBenefit\": \"Co-Insurance\",\n        \"InsuranceType\": \"Medicare Part B\",\n        \"Date\": [{\n            \"Date\": \"01/18/2021\",\n            \"Type\": \"Benefit\"\n        }],\n        \"TimePeriodQualifier\": \"Visit\",\n        \"MonetaryAmount\": null,\n        \"Percent\": \"0%\",\n        \"UsedDate\": null,\n        \"IdentificationCode\": null,\n        \"IdentificationType\": null\n    }]\n}, {\n    \"ProcedureCode\": \"HCPCS|G0499\",\n    \"ProcedureName\": \"Hepatitis B Virus (HCV) in Adults Screening\",\n    \"TechnicalEligibleDate\": \"09/28/2016\",\n    \"ProfessionalEligibleDate\": \"09/28/2016\",\n    \"Benefits\": [{\n        \"EligibilityOrBenefit\": \"Deductible\",\n        \"InsuranceType\": \"Medicare Part B\",\n        \"Date\": [{\n            \"Date\": \"01/18/2021\",\n            \"Type\": \"Benefit\"\n        }],\n        \"TimePeriodQualifier\": \"Calendar Year\",\n        \"MonetaryAmount\": \"$0.00\",\n        \"Percent\": null,\n        \"UsedDate\": null,\n        \"IdentificationCode\": null,\n        \"IdentificationType\": null\n    }, {\n        \"EligibilityOrBenefit\": \"Co-Insurance\",\n        \"InsuranceType\": \"Medicare Part B\",\n        \"Date\": [{\n            \"Date\": \"01/18/2021\",\n            \"Type\": \"Benefit\"\n        }],\n        \"TimePeriodQualifier\": \"Visit\",\n        \"MonetaryAmount\": null,\n        \"Percent\": \"0%\",\n        \"UsedDate\": null,\n        \"IdentificationCode\": null,\n        \"IdentificationType\": null\n    }]\n}, {\n    \"ProcedureCode\": \"HCPCS|84478\",\n    \"ProcedureName\": \"Cardiovascular Disease Screening (CARD)\",\n    \"TechnicalEligibleDate\": \"01/01/2005\",\n    \"ProfessionalEligibleDate\": \"01/01/2005\",\n    \"Benefits\": [{\n        \"EligibilityOrBenefit\": \"Deductible\",\n        \"InsuranceType\": \"Medicare Part B\",\n        \"Date\": [{\n            \"Date\": \"01/18/2021\",\n            \"Type\": \"Benefit\"\n        }],\n        \"TimePeriodQualifier\": \"Calendar Year\",\n        \"MonetaryAmount\": \"$0.00\",\n        \"Percent\": null,\n        \"UsedDate\": null,\n        \"IdentificationCode\": null,\n        \"IdentificationType\": null\n    }, {\n        \"EligibilityOrBenefit\": \"Co-Insurance\",\n        \"InsuranceType\": \"Medicare Part B\",\n        \"Date\": [{\n            \"Date\": \"01/18/2021\",\n            \"Type\": \"Benefit\"\n        }],\n        \"TimePeriodQualifier\": \"Visit\",\n        \"MonetaryAmount\": null,\n        \"Percent\": \"0%\",\n        \"UsedDate\": null,\n        \"IdentificationCode\": null,\n        \"IdentificationType\": null\n    }]\n}, {\n    \"ProcedureCode\": \"HCPCS|83718\",\n    \"ProcedureName\": \"Cardiovascular Disease Screening (CARD)\",\n    \"TechnicalEligibleDate\": \"01/01/2005\",\n    \"ProfessionalEligibleDate\": \"01/01/2005\",\n    \"Benefits\": [{\n        \"EligibilityOrBenefit\": \"Deductible\",\n        \"InsuranceType\": \"Medicare Part B\",\n        \"Date\": [{\n            \"Date\": \"01/18/2021\",\n            \"Type\": \"Benefit\"\n        }],\n        \"TimePeriodQualifier\": \"Calendar Year\",\n        \"MonetaryAmount\": \"$0.00\",\n        \"Percent\": null,\n        \"UsedDate\": null,\n        \"IdentificationCode\": null,\n        \"IdentificationType\": null\n    }, {\n        \"EligibilityOrBenefit\": \"Co-Insurance\",\n        \"InsuranceType\": \"Medicare Part B\",\n        \"Date\": [{\n            \"Date\": \"01/18/2021\",\n            \"Type\": \"Benefit\"\n        }],\n        \"TimePeriodQualifier\": \"Visit\",\n        \"MonetaryAmount\": null,\n        \"Percent\": \"0%\",\n        \"UsedDate\": null,\n        \"IdentificationCode\": null,\n        \"IdentificationType\": null\n    }]\n}, {\n    \"ProcedureCode\": \"HCPCS|82947\",\n    \"ProcedureName\": \"Diabetes Screening Tests (DIAB)\",\n    \"TechnicalEligibleDate\": \"01/01/2005\",\n    \"ProfessionalEligibleDate\": \"01/01/2005\",\n    \"Benefits\": [{\n        \"EligibilityOrBenefit\": \"Deductible\",\n        \"InsuranceType\": \"Medicare Part B\",\n        \"Date\": [{\n            \"Date\": \"01/18/2021\",\n            \"Type\": \"Benefit\"\n        }],\n        \"TimePeriodQualifier\": \"Calendar Year\",\n        \"MonetaryAmount\": \"$0.00\",\n        \"Percent\": null,\n        \"UsedDate\": null,\n        \"IdentificationCode\": null,\n        \"IdentificationType\": null\n    }, {\n        \"EligibilityOrBenefit\": \"Co-Insurance\",\n        \"InsuranceType\": \"Medicare Part B\",\n        \"Date\": [{\n            \"Date\": \"01/18/2021\",\n            \"Type\": \"Benefit\"\n        }],\n        \"TimePeriodQualifier\": \"Visit\",\n        \"MonetaryAmount\": null,\n        \"Percent\": \"0%\",\n        \"UsedDate\": null,\n        \"IdentificationCode\": null,\n        \"IdentificationType\": null\n    }]\n}, {\n    \"ProcedureCode\": \"HCPCS|G0446\",\n    \"ProcedureName\": \"Intensive Behavioral Theropy (IBT) for Cardiovascular Disease (CVD)\",\n    \"TechnicalEligibleDate\": \"11/08/2011\",\n    \"ProfessionalEligibleDate\": \"11/08/2011\",\n    \"Benefits\": [{\n        \"EligibilityOrBenefit\": \"Deductible\",\n        \"InsuranceType\": \"Medicare Part B\",\n        \"Date\": [{\n            \"Date\": \"01/18/2021\",\n            \"Type\": \"Benefit\"\n        }],\n        \"TimePeriodQualifier\": \"Calendar Year\",\n        \"MonetaryAmount\": \"$0.00\",\n        \"Percent\": null,\n        \"UsedDate\": null,\n        \"IdentificationCode\": null,\n        \"IdentificationType\": null\n    }, {\n        \"EligibilityOrBenefit\": \"Co-Insurance\",\n        \"InsuranceType\": \"Medicare Part B\",\n        \"Date\": [{\n            \"Date\": \"01/18/2021\",\n            \"Type\": \"Benefit\"\n        }],\n        \"TimePeriodQualifier\": \"Visit\",\n        \"MonetaryAmount\": null,\n        \"Percent\": \"0%\",\n        \"UsedDate\": null,\n        \"IdentificationCode\": null,\n        \"IdentificationType\": null\n    }]\n}, {\n    \"ProcedureCode\": \"HCPCS|76706\",\n    \"ProcedureName\": \"Ultrasound Screening for Abdominal Aortic Aneurysm (AAA)\",\n    \"TechnicalEligibleDate\": \"07/01/2007\",\n    \"ProfessionalEligibleDate\": \"07/01/2007\",\n    \"Benefits\": [{\n        \"EligibilityOrBenefit\": \"Deductible\",\n        \"InsuranceType\": \"Medicare Part B\",\n        \"Date\": [{\n            \"Date\": \"01/18/2021\",\n            \"Type\": \"Benefit\"\n        }],\n        \"TimePeriodQualifier\": \"Calendar Year\",\n        \"MonetaryAmount\": \"$0.00\",\n        \"Percent\": null,\n        \"UsedDate\": null,\n        \"IdentificationCode\": null,\n        \"IdentificationType\": null\n    }, {\n        \"EligibilityOrBenefit\": \"Co-Insurance\",\n        \"InsuranceType\": \"Medicare Part B\",\n        \"Date\": [{\n            \"Date\": \"01/18/2021\",\n            \"Type\": \"Benefit\"\n        }],\n        \"TimePeriodQualifier\": \"Visit\",\n        \"MonetaryAmount\": null,\n        \"Percent\": \"0%\",\n        \"UsedDate\": null,\n        \"IdentificationCode\": null,\n        \"IdentificationType\": null\n    }]\n}, {\n    \"ProcedureCode\": \"HCPCS|G0438\",\n    \"ProcedureName\": \"Annual Wellness Visit (AMV)\",\n    \"TechnicalEligibleDate\": null,\n    \"ProfessionalEligibleDate\": \"01/01/2011\",\n    \"Benefits\": [{\n        \"EligibilityOrBenefit\": \"Deductible\",\n        \"InsuranceType\": \"Medicare Part B\",\n        \"Date\": [{\n            \"Date\": \"01/18/2021\",\n            \"Type\": \"Benefit\"\n        }],\n        \"TimePeriodQualifier\": \"Calendar Year\",\n        \"MonetaryAmount\": \"$0.00\",\n        \"Percent\": null,\n        \"UsedDate\": null,\n        \"IdentificationCode\": null,\n        \"IdentificationType\": null\n    }, {\n        \"EligibilityOrBenefit\": \"Co-Insurance\",\n        \"InsuranceType\": \"Medicare Part B\",\n        \"Date\": [{\n            \"Date\": \"01/18/2021\",\n            \"Type\": \"Benefit\"\n        }],\n        \"TimePeriodQualifier\": \"Visit\",\n        \"MonetaryAmount\": null,\n        \"Percent\": \"0%\",\n        \"UsedDate\": null,\n        \"IdentificationCode\": null,\n        \"IdentificationType\": null\n    }]\n}, {\n    \"ProcedureCode\": \"HCPCS|G0328\",\n    \"ProcedureName\": \"Fecal Occult Blood Test\",\n    \"TechnicalEligibleDate\": \"01/01/2004\",\n    \"ProfessionalEligibleDate\": \"01/01/2004\",\n    \"Benefits\": [{\n        \"EligibilityOrBenefit\": \"Deductible\",\n        \"InsuranceType\": \"Medicare Part B\",\n        \"Date\": [{\n            \"Date\": \"01/18/2021\",\n            \"Type\": \"Benefit\"\n        }],\n        \"TimePeriodQualifier\": \"Calendar Year\",\n        \"MonetaryAmount\": \"$0.00\",\n        \"Percent\": null,\n        \"UsedDate\": null,\n        \"IdentificationCode\": null,\n        \"IdentificationType\": null\n    }, {\n        \"EligibilityOrBenefit\": \"Co-Insurance\",\n        \"InsuranceType\": \"Medicare Part B\",\n        \"Date\": [{\n            \"Date\": \"01/18/2021\",\n            \"Type\": \"Benefit\"\n        }],\n        \"TimePeriodQualifier\": \"Visit\",\n        \"MonetaryAmount\": null,\n        \"Percent\": \"0%\",\n        \"UsedDate\": null,\n        \"IdentificationCode\": null,\n        \"IdentificationType\": null\n    }]\n}, {\n    \"ProcedureCode\": \"HCPCS|G0442\",\n    \"ProcedureName\": \"Annual Alcohol Misuse Screening\",\n    \"TechnicalEligibleDate\": null,\n    \"ProfessionalEligibleDate\": \"10/14/2011\",\n    \"Benefits\": [{\n        \"EligibilityOrBenefit\": \"Deductible\",\n        \"InsuranceType\": \"Medicare Part B\",\n        \"Date\": [{\n            \"Date\": \"01/18/2021\",\n            \"Type\": \"Benefit\"\n        }],\n        \"TimePeriodQualifier\": \"Calendar Year\",\n        \"MonetaryAmount\": \"$0.00\",\n        \"Percent\": null,\n        \"UsedDate\": null,\n        \"IdentificationCode\": null,\n        \"IdentificationType\": null\n    }, {\n        \"EligibilityOrBenefit\": \"Co-Insurance\",\n        \"InsuranceType\": \"Medicare Part B\",\n        \"Date\": [{\n            \"Date\": \"01/18/2021\",\n            \"Type\": \"Benefit\"\n        }],\n        \"TimePeriodQualifier\": \"Visit\",\n        \"MonetaryAmount\": null,\n        \"Percent\": \"0%\",\n        \"UsedDate\": null,\n        \"IdentificationCode\": null,\n        \"IdentificationType\": null\n    }]\n}, {\n    \"ProcedureCode\": \"HCPCS|G0105\",\n    \"ProcedureName\": \"Colorectal Cancer Screening (COLO)\",\n    \"TechnicalEligibleDate\": \"01/01/1998\",\n    \"ProfessionalEligibleDate\": \"01/01/1998\",\n    \"Benefits\": [{\n        \"EligibilityOrBenefit\": \"Deductible\",\n        \"InsuranceType\": \"Medicare Part B\",\n        \"Date\": [{\n            \"Date\": \"01/18/2021\",\n            \"Type\": \"Benefit\"\n        }],\n        \"TimePeriodQualifier\": \"Calendar Year\",\n        \"MonetaryAmount\": \"$0.00\",\n        \"Percent\": null,\n        \"UsedDate\": null,\n        \"IdentificationCode\": null,\n        \"IdentificationType\": null\n    }, {\n        \"EligibilityOrBenefit\": \"Co-Insurance\",\n        \"InsuranceType\": \"Medicare Part B\",\n        \"Date\": [{\n            \"Date\": \"01/18/2021\",\n            \"Type\": \"Benefit\"\n        }],\n        \"TimePeriodQualifier\": \"Visit\",\n        \"MonetaryAmount\": null,\n        \"Percent\": \"0%\",\n        \"UsedDate\": null,\n        \"IdentificationCode\": null,\n        \"IdentificationType\": null\n    }]\n}, {\n    \"ProcedureCode\": \"HCPCS|82465\",\n    \"ProcedureName\": \"Cardiovascular Disease Screening (CARD)\",\n    \"TechnicalEligibleDate\": \"01/01/2005\",\n    \"ProfessionalEligibleDate\": \"01/01/2005\",\n    \"Benefits\": [{\n        \"EligibilityOrBenefit\": \"Deductible\",\n        \"InsuranceType\": \"Medicare Part B\",\n        \"Date\": [{\n            \"Date\": \"01/18/2021\",\n            \"Type\": \"Benefit\"\n        }],\n        \"TimePeriodQualifier\": \"Calendar Year\",\n        \"MonetaryAmount\": \"$0.00\",\n        \"Percent\": null,\n        \"UsedDate\": null,\n        \"IdentificationCode\": null,\n        \"IdentificationType\": null\n    }, {\n        \"EligibilityOrBenefit\": \"Co-Insurance\",\n        \"InsuranceType\": \"Medicare Part B\",\n        \"Date\": [{\n            \"Date\": \"01/18/2021\",\n            \"Type\": \"Benefit\"\n        }],\n        \"TimePeriodQualifier\": \"Visit\",\n        \"MonetaryAmount\": null,\n        \"Percent\": \"0%\",\n        \"UsedDate\": null,\n        \"IdentificationCode\": null,\n        \"IdentificationType\": null\n    }]\n}, {\n    \"ProcedureCode\": \"HCPCS|G0472\",\n    \"ProcedureName\": \"Hepatitis C Virus (HCV) in Adults Screening\",\n    \"TechnicalEligibleDate\": \"06/02/2014\",\n    \"ProfessionalEligibleDate\": \"06/02/2014\",\n    \"Benefits\": [{\n        \"EligibilityOrBenefit\": \"Deductible\",\n        \"InsuranceType\": \"Medicare Part B\",\n        \"Date\": [{\n            \"Date\": \"01/18/2021\",\n            \"Type\": \"Benefit\"\n        }],\n        \"TimePeriodQualifier\": \"Calendar Year\",\n        \"MonetaryAmount\": \"$0.00\",\n        \"Percent\": null,\n        \"UsedDate\": null,\n        \"IdentificationCode\": null,\n        \"IdentificationType\": null\n    }, {\n        \"EligibilityOrBenefit\": \"Co-Insurance\",\n        \"InsuranceType\": \"Medicare Part B\",\n        \"Date\": [{\n            \"Date\": \"01/18/2021\",\n            \"Type\": \"Benefit\"\n        }],\n        \"TimePeriodQualifier\": \"Visit\",\n        \"MonetaryAmount\": null,\n        \"Percent\": \"0%\",\n        \"UsedDate\": null,\n        \"IdentificationCode\": null,\n        \"IdentificationType\": null\n    }]\n}, {\n    \"ProcedureCode\": \"HCPCS|G0447\",\n    \"ProcedureName\": \"Intensive Behavioral Counselling for Obesity\",\n    \"TechnicalEligibleDate\": \"11/29/2011\",\n    \"ProfessionalEligibleDate\": \"11/29/2011\",\n    \"Benefits\": [{\n        \"EligibilityOrBenefit\": \"Deductible\",\n        \"InsuranceType\": \"Medicare Part B\",\n        \"Date\": [{\n            \"Date\": \"01/18/2021\",\n            \"Type\": \"Benefit\"\n        }],\n        \"TimePeriodQualifier\": \"Calendar Year\",\n        \"MonetaryAmount\": \"$0.00\",\n        \"Percent\": null,\n        \"UsedDate\": null,\n        \"IdentificationCode\": null,\n        \"IdentificationType\": null\n    }, {\n        \"EligibilityOrBenefit\": \"Co-Insurance\",\n        \"InsuranceType\": \"Medicare Part B\",\n        \"Date\": [{\n            \"Date\": \"01/18/2021\",\n            \"Type\": \"Benefit\"\n        }],\n        \"TimePeriodQualifier\": \"Visit\",\n        \"MonetaryAmount\": null,\n        \"Percent\": \"0%\",\n        \"UsedDate\": null,\n        \"IdentificationCode\": null,\n        \"IdentificationType\": null\n    }]\n}, {\n    \"ProcedureCode\": \"HCPCS|G0473\",\n    \"ProcedureName\": \"Intensive Behavioral Counselling for Obesity\",\n    \"TechnicalEligibleDate\": \"01/01/2015\",\n    \"ProfessionalEligibleDate\": \"01/01/2015\",\n    \"Benefits\": [{\n        \"EligibilityOrBenefit\": \"Deductible\",\n        \"InsuranceType\": \"Medicare Part B\",\n        \"Date\": [{\n            \"Date\": \"01/18/2021\",\n            \"Type\": \"Benefit\"\n        }],\n        \"TimePeriodQualifier\": \"Calendar Year\",\n        \"MonetaryAmount\": \"$0.00\",\n        \"Percent\": null,\n        \"UsedDate\": null,\n        \"IdentificationCode\": null,\n        \"IdentificationType\": null\n    }, {\n        \"EligibilityOrBenefit\": \"Co-Insurance\",\n        \"InsuranceType\": \"Medicare Part B\",\n        \"Date\": [{\n            \"Date\": \"01/18/2021\",\n            \"Type\": \"Benefit\"\n        }],\n        \"TimePeriodQualifier\": \"Visit\",\n        \"MonetaryAmount\": null,\n        \"Percent\": \"0%\",\n        \"UsedDate\": null,\n        \"IdentificationCode\": null,\n        \"IdentificationType\": null\n    }]\n}, {\n    \"ProcedureCode\": \"HCPCS|G0106\",\n    \"ProcedureName\": \"Colorectal Cancer Screening (COLO)\",\n    \"TechnicalEligibleDate\": \"04/23/1998\",\n    \"ProfessionalEligibleDate\": \"04/23/1998\",\n    \"Benefits\": [{\n        \"EligibilityOrBenefit\": \"Deductible\",\n        \"InsuranceType\": \"Medicare Part B\",\n        \"Date\": [{\n            \"Date\": \"01/18/2021\",\n            \"Type\": \"Benefit\"\n        }],\n        \"TimePeriodQualifier\": \"Calendar Year\",\n        \"MonetaryAmount\": \"$0.00\",\n        \"Percent\": null,\n        \"UsedDate\": null,\n        \"IdentificationCode\": null,\n        \"IdentificationType\": null\n    }]\n}, {\n    \"ProcedureCode\": \"HCPCS|71271\",\n    \"ProcedureName\": \"Computed tomography, thorax, low dose for lung cancer screening, without contrast material(s)\",\n    \"TechnicalEligibleDate\": \"02/05/2015\",\n    \"ProfessionalEligibleDate\": \"02/05/2015\",\n    \"Benefits\": [{\n        \"EligibilityOrBenefit\": \"Deductible\",\n        \"InsuranceType\": \"Medicare Part B\",\n        \"Date\": [{\n            \"Date\": \"01/18/2021\",\n            \"Type\": \"Benefit\"\n        }],\n        \"TimePeriodQualifier\": \"Calendar Year\",\n        \"MonetaryAmount\": \"$0.00\",\n        \"Percent\": null,\n        \"UsedDate\": null,\n        \"IdentificationCode\": null,\n        \"IdentificationType\": null\n    }, {\n        \"EligibilityOrBenefit\": \"Co-Insurance\",\n        \"InsuranceType\": \"Medicare Part B\",\n        \"Date\": [{\n            \"Date\": \"01/18/2021\",\n            \"Type\": \"Benefit\"\n        }],\n        \"TimePeriodQualifier\": \"Visit\",\n        \"MonetaryAmount\": null,\n        \"Percent\": \"0%\",\n        \"UsedDate\": null,\n        \"IdentificationCode\": null,\n        \"IdentificationType\": null\n    }]\n}, {\n    \"ProcedureCode\": \"HCPCS|G0475\",\n    \"ProcedureName\": \"Human Immunodeficiency Virus (HIV) Infection Screening\",\n    \"TechnicalEligibleDate\": \"04/13/2015\",\n    \"ProfessionalEligibleDate\": null,\n    \"Benefits\": [{\n        \"EligibilityOrBenefit\": \"Deductible\",\n        \"InsuranceType\": \"Medicare Part B\",\n        \"Date\": [{\n            \"Date\": \"01/18/2021\",\n            \"Type\": \"Benefit\"\n        }],\n        \"TimePeriodQualifier\": \"Calendar Year\",\n        \"MonetaryAmount\": \"$0.00\",\n        \"Percent\": null,\n        \"UsedDate\": null,\n        \"IdentificationCode\": null,\n        \"IdentificationType\": null\n    }, {\n        \"EligibilityOrBenefit\": \"Co-Insurance\",\n        \"InsuranceType\": \"Medicare Part B\",\n        \"Date\": [{\n            \"Date\": \"01/18/2021\",\n            \"Type\": \"Benefit\"\n        }],\n        \"TimePeriodQualifier\": \"Visit\",\n        \"MonetaryAmount\": null,\n        \"Percent\": \"0%\",\n        \"UsedDate\": null,\n        \"IdentificationCode\": null,\n        \"IdentificationType\": null\n    }]\n}, {\n    \"ProcedureCode\": \"HCPCS|G0103\",\n    \"ProcedureName\": \"Prostate Cancer Screening (PROS)\",\n    \"TechnicalEligibleDate\": \"11/01/2001\",\n    \"ProfessionalEligibleDate\": \"02/01/2005\",\n    \"Benefits\": [{\n        \"EligibilityOrBenefit\": \"Deductible\",\n        \"InsuranceType\": \"Medicare Part B\",\n        \"Date\": [{\n            \"Date\": \"01/18/2021\",\n            \"Type\": \"Benefit\"\n        }],\n        \"TimePeriodQualifier\": \"Calendar Year\",\n        \"MonetaryAmount\": \"$0.00\",\n        \"Percent\": null,\n        \"UsedDate\": null,\n        \"IdentificationCode\": null,\n        \"IdentificationType\": null\n    }, {\n        \"EligibilityOrBenefit\": \"Co-Insurance\",\n        \"InsuranceType\": \"Medicare Part B\",\n        \"Date\": [{\n            \"Date\": \"01/18/2021\",\n            \"Type\": \"Benefit\"\n        }],\n        \"TimePeriodQualifier\": \"Visit\",\n        \"MonetaryAmount\": null,\n        \"Percent\": \"0%\",\n        \"UsedDate\": null,\n        \"IdentificationCode\": null,\n        \"IdentificationType\": null\n    }]\n}, {\n    \"ProcedureCode\": \"HCPCS|80061\",\n    \"ProcedureName\": \"Cardiovascular Disease Screening (CARD)\",\n    \"TechnicalEligibleDate\": \"01/01/2005\",\n    \"ProfessionalEligibleDate\": \"01/01/2005\",\n    \"Benefits\": [{\n        \"EligibilityOrBenefit\": \"Deductible\",\n        \"InsuranceType\": \"Medicare Part B\",\n        \"Date\": [{\n            \"Date\": \"01/18/2021\",\n            \"Type\": \"Benefit\"\n        }],\n        \"TimePeriodQualifier\": \"Calendar Year\",\n        \"MonetaryAmount\": \"$0.00\",\n        \"Percent\": null,\n        \"UsedDate\": null,\n        \"IdentificationCode\": null,\n        \"IdentificationType\": null\n    }, {\n        \"EligibilityOrBenefit\": \"Co-Insurance\",\n        \"InsuranceType\": \"Medicare Part B\",\n        \"Date\": [{\n            \"Date\": \"01/18/2021\",\n            \"Type\": \"Benefit\"\n        }],\n        \"TimePeriodQualifier\": \"Visit\",\n        \"MonetaryAmount\": null,\n        \"Percent\": \"0%\",\n        \"UsedDate\": null,\n        \"IdentificationCode\": null,\n        \"IdentificationType\": null\n    }]\n}, {\n    \"ProcedureCode\": \"HCPCS|81528\",\n    \"ProcedureName\": \"Colorectal Cancer Screening (COLO)\",\n    \"TechnicalEligibleDate\": \"10/09/2014\",\n    \"ProfessionalEligibleDate\": null,\n    \"Benefits\": [{\n        \"EligibilityOrBenefit\": \"Deductible\",\n        \"InsuranceType\": \"Medicare Part B\",\n        \"Date\": [{\n            \"Date\": \"01/18/2021\",\n            \"Type\": \"Benefit\"\n        }],\n        \"TimePeriodQualifier\": \"Calendar Year\",\n        \"MonetaryAmount\": \"$0.00\",\n        \"Percent\": null,\n        \"UsedDate\": null,\n        \"IdentificationCode\": null,\n        \"IdentificationType\": null\n    }, {\n        \"EligibilityOrBenefit\": \"Co-Insurance\",\n        \"InsuranceType\": \"Medicare Part B\",\n        \"Date\": [{\n            \"Date\": \"01/18/2021\",\n            \"Type\": \"Benefit\"\n        }],\n        \"TimePeriodQualifier\": \"Visit\",\n        \"MonetaryAmount\": null,\n        \"Percent\": \"0%\",\n        \"UsedDate\": null,\n        \"IdentificationCode\": null,\n        \"IdentificationType\": null\n    }]\n}, {\n    \"ProcedureCode\": \"HCPCS|82950\",\n    \"ProcedureName\": \"Diabetes Screening Tests (DIAB)\",\n    \"TechnicalEligibleDate\": \"01/01/2005\",\n    \"ProfessionalEligibleDate\": \"01/01/2005\",\n    \"Benefits\": [{\n        \"EligibilityOrBenefit\": \"Deductible\",\n        \"InsuranceType\": \"Medicare Part B\",\n        \"Date\": [{\n            \"Date\": \"01/18/2021\",\n            \"Type\": \"Benefit\"\n        }],\n        \"TimePeriodQualifier\": \"Calendar Year\",\n        \"MonetaryAmount\": \"$0.00\",\n        \"Percent\": null,\n        \"UsedDate\": null,\n        \"IdentificationCode\": null,\n        \"IdentificationType\": null\n    }, {\n        \"EligibilityOrBenefit\": \"Co-Insurance\",\n        \"InsuranceType\": \"Medicare Part B\",\n        \"Date\": [{\n            \"Date\": \"01/18/2021\",\n            \"Type\": \"Benefit\"\n        }],\n        \"TimePeriodQualifier\": \"Visit\",\n        \"MonetaryAmount\": null,\n        \"Percent\": \"0%\",\n        \"UsedDate\": null,\n        \"IdentificationCode\": null,\n        \"IdentificationType\": null\n    }]\n}, {\n    \"ProcedureCode\": \"HCPCS|G0104\",\n    \"ProcedureName\": \"Colorectal Cancer Screening (COLO)\",\n    \"TechnicalEligibleDate\": \"04/23/1998\",\n    \"ProfessionalEligibleDate\": \"04/23/1998\",\n    \"Benefits\": [{\n        \"EligibilityOrBenefit\": \"Deductible\",\n        \"InsuranceType\": \"Medicare Part B\",\n        \"Date\": [{\n            \"Date\": \"01/18/2021\",\n            \"Type\": \"Benefit\"\n        }],\n        \"TimePeriodQualifier\": \"Calendar Year\",\n        \"MonetaryAmount\": \"$0.00\",\n        \"Percent\": null,\n        \"UsedDate\": null,\n        \"IdentificationCode\": null,\n        \"IdentificationType\": null\n    }, {\n        \"EligibilityOrBenefit\": \"Co-Insurance\",\n        \"InsuranceType\": \"Medicare Part B\",\n        \"Date\": [{\n            \"Date\": \"01/18/2021\",\n            \"Type\": \"Benefit\"\n        }],\n        \"TimePeriodQualifier\": \"Visit\",\n        \"MonetaryAmount\": null,\n        \"Percent\": \"0%\",\n        \"UsedDate\": null,\n        \"IdentificationCode\": null,\n        \"IdentificationType\": null\n    }]\n}, {\n    \"ProcedureCode\": \"HCPCS|G0445\",\n    \"ProcedureName\": \"Screening and High Intensive Behavioral Counseling (HIBC) to prevent STIs\",\n    \"TechnicalEligibleDate\": \"11/08/2011\",\n    \"ProfessionalEligibleDate\": \"11/08/2011\",\n    \"Benefits\": [{\n        \"EligibilityOrBenefit\": \"Deductible\",\n        \"InsuranceType\": \"Medicare Part B\",\n        \"Date\": [{\n            \"Date\": \"01/18/2021\",\n            \"Type\": \"Benefit\"\n        }],\n        \"TimePeriodQualifier\": \"Calendar Year\",\n        \"MonetaryAmount\": \"$0.00\",\n        \"Percent\": null,\n        \"UsedDate\": null,\n        \"IdentificationCode\": null,\n        \"IdentificationType\": null\n    }, {\n        \"EligibilityOrBenefit\": \"Co-Insurance\",\n        \"InsuranceType\": \"Medicare Part B\",\n        \"Date\": [{\n            \"Date\": \"01/18/2021\",\n            \"Type\": \"Benefit\"\n        }],\n        \"TimePeriodQualifier\": \"Visit\",\n        \"MonetaryAmount\": null,\n        \"Percent\": \"0%\",\n        \"UsedDate\": null,\n        \"IdentificationCode\": null,\n        \"IdentificationType\": null\n    }]\n}, {\n    \"ProcedureCode\": \"HCPCS|82951\",\n    \"ProcedureName\": \"Diabetes Screening Tests (DIAB)\",\n    \"TechnicalEligibleDate\": \"01/01/2005\",\n    \"ProfessionalEligibleDate\": \"01/01/2005\",\n    \"Benefits\": [{\n        \"EligibilityOrBenefit\": \"Deductible\",\n        \"InsuranceType\": \"Medicare Part B\",\n        \"Date\": [{\n            \"Date\": \"01/18/2021\",\n            \"Type\": \"Benefit\"\n        }],\n        \"TimePeriodQualifier\": \"Calendar Year\",\n        \"MonetaryAmount\": \"$0.00\",\n        \"Percent\": null,\n        \"UsedDate\": null,\n        \"IdentificationCode\": null,\n        \"IdentificationType\": null\n    }, {\n        \"EligibilityOrBenefit\": \"Co-Insurance\",\n        \"InsuranceType\": \"Medicare Part B\",\n        \"Date\": [{\n            \"Date\": \"01/18/2021\",\n            \"Type\": \"Benefit\"\n        }],\n        \"TimePeriodQualifier\": \"Visit\",\n        \"MonetaryAmount\": null,\n        \"Percent\": \"0%\",\n        \"UsedDate\": null,\n        \"IdentificationCode\": null,\n        \"IdentificationType\": null\n    }]\n}, {\n    \"ProcedureCode\": \"HCPCS|G0439\",\n    \"ProcedureName\": \"Annual Wellness Visit (AMV)\",\n    \"TechnicalEligibleDate\": null,\n    \"ProfessionalEligibleDate\": \"01/01/2011\",\n    \"Benefits\": [{\n        \"EligibilityOrBenefit\": \"Deductible\",\n        \"InsuranceType\": \"Medicare Part B\",\n        \"Date\": [{\n            \"Date\": \"01/18/2021\",\n            \"Type\": \"Benefit\"\n        }],\n        \"TimePeriodQualifier\": \"Calendar Year\",\n        \"MonetaryAmount\": \"$0.00\",\n        \"Percent\": null,\n        \"UsedDate\": null,\n        \"IdentificationCode\": null,\n        \"IdentificationType\": null\n    }, {\n        \"EligibilityOrBenefit\": \"Co-Insurance\",\n        \"InsuranceType\": \"Medicare Part B\",\n        \"Date\": [{\n            \"Date\": \"01/18/2021\",\n            \"Type\": \"Benefit\"\n        }],\n        \"TimePeriodQualifier\": \"Visit\",\n        \"MonetaryAmount\": null,\n        \"Percent\": \"0%\",\n        \"UsedDate\": null,\n        \"IdentificationCode\": null,\n        \"IdentificationType\": null\n    }]\n}, {\n    \"ProcedureCode\": \"HCPCS|82270\",\n    \"ProcedureName\": \"Fecal Occult Blood Test\",\n    \"TechnicalEligibleDate\": \"01/01/2007\",\n    \"ProfessionalEligibleDate\": \"01/01/2007\",\n    \"Benefits\": [{\n        \"EligibilityOrBenefit\": \"Deductible\",\n        \"InsuranceType\": \"Medicare Part B\",\n        \"Date\": [{\n            \"Date\": \"01/18/2021\",\n            \"Type\": \"Benefit\"\n        }],\n        \"TimePeriodQualifier\": \"Calendar Year\",\n        \"MonetaryAmount\": \"$0.00\",\n        \"Percent\": null,\n        \"UsedDate\": null,\n        \"IdentificationCode\": null,\n        \"IdentificationType\": null\n    }, {\n        \"EligibilityOrBenefit\": \"Co-Insurance\",\n        \"InsuranceType\": \"Medicare Part B\",\n        \"Date\": [{\n            \"Date\": \"01/18/2021\",\n            \"Type\": \"Benefit\"\n        }],\n        \"TimePeriodQualifier\": \"Visit\",\n        \"MonetaryAmount\": null,\n        \"Percent\": \"0%\",\n        \"UsedDate\": null,\n        \"IdentificationCode\": null,\n        \"IdentificationType\": null\n    }]\n}, {\n    \"ProcedureCode\": \"HCPCS|G0120\",\n    \"ProcedureName\": \"Colorectal Cancer Screening (COLO)\",\n    \"TechnicalEligibleDate\": \"04/23/1998\",\n    \"ProfessionalEligibleDate\": \"04/23/1998\",\n    \"Benefits\": [{\n        \"EligibilityOrBenefit\": \"Deductible\",\n        \"InsuranceType\": \"Medicare Part B\",\n        \"Date\": [{\n            \"Date\": \"01/18/2021\",\n            \"Type\": \"Benefit\"\n        }],\n        \"TimePeriodQualifier\": \"Calendar Year\",\n        \"MonetaryAmount\": \"$0.00\",\n        \"Percent\": null,\n        \"UsedDate\": null,\n        \"IdentificationCode\": null,\n        \"IdentificationType\": null\n    }]\n}, {\n    \"ProcedureCode\": \"HCPCS|G0121\",\n    \"ProcedureName\": \"Colorectal Cancer Screening (COLO)\",\n    \"TechnicalEligibleDate\": \"07/01/2001\",\n    \"ProfessionalEligibleDate\": \"07/01/2001\",\n    \"Benefits\": [{\n        \"EligibilityOrBenefit\": \"Deductible\",\n        \"InsuranceType\": \"Medicare Part B\",\n        \"Date\": [{\n            \"Date\": \"01/18/2021\",\n            \"Type\": \"Benefit\"\n        }],\n        \"TimePeriodQualifier\": \"Calendar Year\",\n        \"MonetaryAmount\": \"$0.00\",\n        \"Percent\": null,\n        \"UsedDate\": null,\n        \"IdentificationCode\": null,\n        \"IdentificationType\": null\n    }, {\n        \"EligibilityOrBenefit\": \"Co-Insurance\",\n        \"InsuranceType\": \"Medicare Part B\",\n        \"Date\": [{\n            \"Date\": \"01/18/2021\",\n            \"Type\": \"Benefit\"\n        }],\n        \"TimePeriodQualifier\": \"Visit\",\n        \"MonetaryAmount\": null,\n        \"Percent\": \"0%\",\n        \"UsedDate\": null,\n        \"IdentificationCode\": null,\n        \"IdentificationType\": null\n    }]\n}, {\n    \"ProcedureCode\": \"HCPCS|76977\",\n    \"ProcedureName\": \"Ultrasound Bone Density Measurement and Interpretation\",\n    \"TechnicalEligibleDate\": \"07/01/1998\",\n    \"ProfessionalEligibleDate\": \"07/01/1998\",\n    \"Benefits\": [{\n        \"EligibilityOrBenefit\": \"Deductible\",\n        \"InsuranceType\": \"Medicare Part B\",\n        \"Date\": [{\n            \"Date\": \"01/18/2021\",\n            \"Type\": \"Benefit\"\n        }],\n        \"TimePeriodQualifier\": \"Calendar Year\",\n        \"MonetaryAmount\": \"$0.00\",\n        \"Percent\": null,\n        \"UsedDate\": null,\n        \"IdentificationCode\": null,\n        \"IdentificationType\": null\n    }, {\n        \"EligibilityOrBenefit\": \"Co-Insurance\",\n        \"InsuranceType\": \"Medicare Part B\",\n        \"Date\": [{\n            \"Date\": \"01/18/2021\",\n            \"Type\": \"Benefit\"\n        }],\n        \"TimePeriodQualifier\": \"Visit\",\n        \"MonetaryAmount\": null,\n        \"Percent\": \"0%\",\n        \"UsedDate\": null,\n        \"IdentificationCode\": null,\n        \"IdentificationType\": null\n    }]\n}, {\n    \"ProcedureCode\": \"HCPCS|77078\",\n    \"ProcedureName\": \"Computed Tomography Bone Mineral Density Study\",\n    \"TechnicalEligibleDate\": \"07/01/1998\",\n    \"ProfessionalEligibleDate\": \"07/01/1998\",\n    \"Benefits\": [{\n        \"EligibilityOrBenefit\": \"Deductible\",\n        \"InsuranceType\": \"Medicare Part B\",\n        \"Date\": [{\n            \"Date\": \"01/18/2021\",\n            \"Type\": \"Benefit\"\n        }],\n        \"TimePeriodQualifier\": \"Calendar Year\",\n        \"MonetaryAmount\": \"$0.00\",\n        \"Percent\": null,\n        \"UsedDate\": null,\n        \"IdentificationCode\": null,\n        \"IdentificationType\": null\n    }, {\n        \"EligibilityOrBenefit\": \"Co-Insurance\",\n        \"InsuranceType\": \"Medicare Part B\",\n        \"Date\": [{\n            \"Date\": \"01/18/2021\",\n            \"Type\": \"Benefit\"\n        }],\n        \"TimePeriodQualifier\": \"Visit\",\n        \"MonetaryAmount\": null,\n        \"Percent\": \"0%\",\n        \"UsedDate\": null,\n        \"IdentificationCode\": null,\n        \"IdentificationType\": null\n    }]\n}, {\n    \"ProcedureCode\": \"HCPCS|77080\",\n    \"ProcedureName\": \"Dual Energy X-ray Absorptiometry (DXA) Bone Density Study; axial skeleton\",\n    \"TechnicalEligibleDate\": \"07/01/1998\",\n    \"ProfessionalEligibleDate\": \"07/01/1998\",\n    \"Benefits\": [{\n        \"EligibilityOrBenefit\": \"Deductible\",\n        \"InsuranceType\": \"Medicare Part B\",\n        \"Date\": [{\n            \"Date\": \"01/18/2021\",\n            \"Type\": \"Benefit\"\n        }],\n        \"TimePeriodQualifier\": \"Calendar Year\",\n        \"MonetaryAmount\": \"$0.00\",\n        \"Percent\": null,\n        \"UsedDate\": null,\n        \"IdentificationCode\": null,\n        \"IdentificationType\": null\n    }, {\n        \"EligibilityOrBenefit\": \"Co-Insurance\",\n        \"InsuranceType\": \"Medicare Part B\",\n        \"Date\": [{\n            \"Date\": \"01/18/2021\",\n            \"Type\": \"Benefit\"\n        }],\n        \"TimePeriodQualifier\": \"Visit\",\n        \"MonetaryAmount\": null,\n        \"Percent\": \"0%\",\n        \"UsedDate\": null,\n        \"IdentificationCode\": null,\n        \"IdentificationType\": null\n    }]\n}, {\n    \"ProcedureCode\": \"HCPCS|77081\",\n    \"ProcedureName\": \"DXA Bone Density Study; appendicular skeleton\",\n    \"TechnicalEligibleDate\": \"07/01/1998\",\n    \"ProfessionalEligibleDate\": \"07/01/1998\",\n    \"Benefits\": [{\n        \"EligibilityOrBenefit\": \"Deductible\",\n        \"InsuranceType\": \"Medicare Part B\",\n        \"Date\": [{\n            \"Date\": \"01/18/2021\",\n            \"Type\": \"Benefit\"\n        }],\n        \"TimePeriodQualifier\": \"Calendar Year\",\n        \"MonetaryAmount\": \"$0.00\",\n        \"Percent\": null,\n        \"UsedDate\": null,\n        \"IdentificationCode\": null,\n        \"IdentificationType\": null\n    }, {\n        \"EligibilityOrBenefit\": \"Co-Insurance\",\n        \"InsuranceType\": \"Medicare Part B\",\n        \"Date\": [{\n            \"Date\": \"01/18/2021\",\n            \"Type\": \"Benefit\"\n        }],\n        \"TimePeriodQualifier\": \"Visit\",\n        \"MonetaryAmount\": null,\n        \"Percent\": \"0%\",\n        \"UsedDate\": null,\n        \"IdentificationCode\": null,\n        \"IdentificationType\": null\n    }]\n}, {\n    \"ProcedureCode\": \"HCPCS|G0130\",\n    \"ProcedureName\": \"Single Energy X-ray Study\",\n    \"TechnicalEligibleDate\": \"07/01/1998\",\n    \"ProfessionalEligibleDate\": \"07/01/1998\",\n    \"Benefits\": [{\n        \"EligibilityOrBenefit\": \"Deductible\",\n        \"InsuranceType\": \"Medicare Part B\",\n        \"Date\": [{\n            \"Date\": \"01/18/2021\",\n            \"Type\": \"Benefit\"\n        }],\n        \"TimePeriodQualifier\": \"Calendar Year\",\n        \"MonetaryAmount\": \"$0.00\",\n        \"Percent\": null,\n        \"UsedDate\": null,\n        \"IdentificationCode\": null,\n        \"IdentificationType\": null\n    }, {\n        \"EligibilityOrBenefit\": \"Co-Insurance\",\n        \"InsuranceType\": \"Medicare Part B\",\n        \"Date\": [{\n            \"Date\": \"01/18/2021\",\n            \"Type\": \"Benefit\"\n        }],\n        \"TimePeriodQualifier\": \"Visit\",\n        \"MonetaryAmount\": null,\n        \"Percent\": \"0%\",\n        \"UsedDate\": null,\n        \"IdentificationCode\": null,\n        \"IdentificationType\": null\n    }]\n}, {\n    \"ProcedureCode\": \"HCPCS|G0118\",\n    \"ProcedureName\": \"Glaucoma Screening (GLAU)\",\n    \"TechnicalEligibleDate\": \"01/01/2002\",\n    \"ProfessionalEligibleDate\": \"01/01/2002\",\n    \"Benefits\": null\n}, {\n    \"ProcedureCode\": \"HCPCS|G0102\",\n    \"ProcedureName\": \"Prostate Cancer Screening (PROS)\",\n    \"TechnicalEligibleDate\": \"01/01/2000\",\n    \"ProfessionalEligibleDate\": \"01/01/2000\",\n    \"Benefits\": null\n}, {\n    \"ProcedureCode\": \"HCPCS|G0117\",\n    \"ProcedureName\": \"Glaucoma Screening (GLAU)\",\n    \"TechnicalEligibleDate\": \"01/01/2002\",\n    \"ProfessionalEligibleDate\": \"01/01/2002\",\n    \"Benefits\": null\n}]\n\n

Medicare SNF and Other Information

Using EligibilitySummary or EasyEligibilitySummary, for Medicare, you can obtain details in a new section \"MedicareInfoSummary\". The response object is to the right and returns SNF information, MCA information, Pharmacy payer, and other Medicare specific information.

    \"MedicareInfoSummary\": {\n        \"HospiceQty\": null,\n        \"HospiceDate\": null,\n        \"HomeHealthCareStartDate\": null,\n        \"HomeHealthCareEndDate\": null,\n        \"SkilledNursingCareStartDate\": null,\n        \"SkilledNursingCareEndDate\": null,\n        \"AdvantagePayerName\": null,\n        \"AdvantageCOBDate\": null,\n        \"AdvantagePolicyType\": null,\n        \"PharmacyPayerName\": \"SILVERSCRIPT INSURANCE COMPANY\",\n        \"PharmacyPayerPlanNumber\": \"S5601\",\n        \"PharmacyPayerPlanNetworkID\": \"034\",\n        \"WCAutoInjuryLiabilityPayerName\": null,\n        \"WCAutoInjuryLiabilityCOBDate\": null,\n        \"WCAutoInjuryLiabilityPolicyType\": null,\n        \"QMBPolicyType\": null,\n        \"Part_A_Deductible\": null,\n        \"Part_A_Deductible_Remaining\": \"$1364.00\",\n        \"Part_B_Deductible\": \"$185.00\",\n        \"Part_B_Deductible_Remaining\": \"$0.00\",\n        \"OT_UsedAmount\": null,\n        \"PT_SLP_UsedAmount\": null\n    },\n\n

Further under the OtherPayerInfo section you can find Third Party Administrators and other information.

    \"OtherPayerInfo\": {\n        \"PrimaryPayer\": null,\n        \"Payer\": null,\n        \"SecondaryPayer\": null,\n        \"PlanSponsor\": null,\n        \"IndependentPhysiciansAssociation_IPA\": null,\n        \"WorkersCompensation\": null,\n        \"ContractedServiceProvider\": null\n    },\n\n

Backoffice Payers

An important concept to understand with pVerify eligibility endpoints is the concept of a \"back office\" payer. To support 99% of available payers we need to connect to some payers via non-electronic means. These payers will not work with a real-time API with a immediate response expected.

EDI Payer Workflow

Generate Token
\n
Call EligibilityInquiry to submit request to our queue and get elgRequestID
\n

Backoffice Payer Workflow

Generate Token
\n
Call EligibilityInquiry to submit request to our queue and get elgRequestID
\n
After a period of 24 hours, call GetEligibilityResponse using elgRequestID above.
\n

We have two methods available for back-office queue management:

GetPendingInquiries this shows a list of your inquiries that are still in Pending state
\n
CancelTransaction to set the state to Cancel and remove it from our queue.
\n

Client Libraries and Sample Code

To simplify authorization and access to the pVerify API, we provide sample code in C# and libraries in Java. These libraries offer full access to the pVerify API with a minimum of code.

C# Sample Code

Java Sample Code

\n","schema":"https://schema.getpostman.com/json/collection/v2.0.0/collection.json","toc":[{"content":"Available Endpoints","slug":"available-endpoints"},{"content":"Medicare HCPCS codes","slug":"medicare-hcpcs-codes"},{"content":"Medicare SNF and Other Information","slug":"medicare-snf-and-other-information"},{"content":"Backoffice Payers","slug":"backoffice-payers"},{"content":"Client Libraries and Sample Code","slug":"client-libraries-and-sample-code"}],"owner":"6948370","collectionId":"6ceb8797-50ff-42fd-98a3-64beefaa6c94","publishedId":"2s7ZE4NR6P","public":true,"customColor":{"top-bar":"FFFFFF","right-sidebar":"303030","highlight":"EF5B25"},"publishDate":"2022-09-22T10:46:13.000Z"},"item":[{"name":"Security and Authorization","item":[{"name":"Token","id":"d84ac4d8-db8b-47bb-b5c7-5c61726c8466","protocolProfileBehavior":{"disableBodyPruning":true},"request":{"method":"POST","header":[],"body":{"mode":"urlencoded","urlencoded":[{"key":"Client_Id","value":"{{client-api-id}}","type":"text"},{"key":"Client_Secret","value":"{{client-secret}}","type":"text"},{"key":"grant_type","value":"client_credentials","type":"text"},{"key":"","value":"","type":"text"}]},"url":"https://api.pverify.com/Token","description":"

\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n

Environment	URL
Test	https://testapi.pverify.com/Token
Production	https://api.pverify.com/Token

The first step to using the system is a call to the Token endpoint at /Token. It will return a token when you use in the subsequent calls.

Token Authorization Request

\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n

Header	Description
Method	POST
URL	https://api.pverify.com/Token
Content-Type	application/x-www-form-urlencoded
URL Params	None
Body	Description
Data Params*	\"Client_Id=\" + clientID + \"&client_secret=\" + ClientSecret + \"&grant_type=client_credentials\"

*Note: The Client-API-Id header is required. Header keys are case sensitive.

The /Token response includes the following fields:

\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n

Field	Type	Description
access_token	{string}	Authorization token unique to you which is used to verify your authorization for subsequent calls.
token_type	{string}	this is the token type which will be included before the access token in your subsequent method calls.
expires_in	{int}	This is the amount of time that your token is valid for (in seconds).

","urlObject":{"protocol":"https","path":["Token"],"host":["api","pverify","com"],"query":[],"variable":[]}},"response":[],"_postman_id":"d84ac4d8-db8b-47bb-b5c7-5c61726c8466"}],"id":"966c44b5-9f9f-4b12-bb28-dc903f6bf70c","description":"

pVerify allows access to the Real-time Exchange System through the use of a client-api-id and client-secret. These must be requested from pVerify and are available via our API management site. The client-api-id and client-secret are used for the Token call, while the Token and client-api-id are used for subsequent calls. Please see the demo video for an example.

Once the token is obtained, add these two headers to all subsequent calls:

Authorization: Bearer (your token)

Client-API-Id: (your client ID from API Management site)

\n","event":[{"listen":"prerequest","script":{"id":"840276cb-fe48-45cb-9a9a-17e1ef5f6f9e","type":"text/javascript","exec":[""]}},{"listen":"test","script":{"id":"5e465b46-c6d8-4231-b239-943e328dfd5d","type":"text/javascript","exec":[""]}}],"_postman_id":"966c44b5-9f9f-4b12-bb28-dc903f6bf70c"},{"name":"Eligibility","item":[{"name":"EligibilitySummary","id":"b618599e-5e2a-407e-b61e-ecb37bc7e0c9","protocolProfileBehavior":{"disableBodyPruning":true},"request":{"method":"POST","header":[{"key":"Authorization","value":"Bearer {{access-token}}","type":"text"},{"key":"Client-API-Id","value":"{{client-api-id}}","type":"text"},{"key":"Content-Type","value":"application/json","type":"text"}],"body":{"mode":"raw","raw":"{\r\n \"payerCode\": \"00192\",\r\n \"payerName\": \"UHC\",\r\n \"provider\": {\r\n \"firstName\": \"\",\r\n \"middleName\": \"\",\r\n \"lastName\": \" provider last name\",\r\n \"npi\": \"1234567890\",\r\n \"pin\":\"00000\"\r\n },\r\n\r\n \"subscriber\": {\r\n \"firstName\": \"fname\",\r\n \"dob\": \"mm/dd/yyyy\",\r\n \"lastName\": \"lname\",\r\n \"memberID\": \"123sfadfaf\"\r\n },\r\n\r\n \"dependent\": null,\r\n \"isSubscriberPatient\": \"True\",\r\n \"doS_StartDate\": \"02/02/2021\",\r\n \"doS_EndDate\": \"02/02/2021\",\r\n\r\n \"PracticeTypeCode\":\"3\",\r\n \"referenceId\":\"Pat MRN\",\r\n \"Location\":\"Any location Name\",\r\n \"IncludeTextResponse\":\"false\",\r\n \"InternalId\":\"\",\r\n \"CustomerID\":\"\",\r\n \"PlaceOfService\":\"01\"\r\n}"},"url":"https://api.pverify.com/api/EligibilitySummary","description":"

\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n

Environment	URL
Test	https://testapi.pverify.com/API/EligibilitySummary
Production	https://api.pverify.com/API/EligibilitySummary

Eligibility summary is our 2nd gen eligibility endpoint designed to cover the vast majority of payers and return simplified objects with key data such as copay for your practice type. For example, when you send as practice type PT, we will return a Physical Therapy object with key PT benefits.

Key benefits are:

Easy and discrete eligibility information, allowing easy coding to obtain pertinent data.
\n
Support for nearly all types of medical practices with key benefits such as surgical benefits, DME benefits, or PT benefits.
\n
Support for nearly all payers, electronic and non electronic. We have tested all payers available to us and over 90% are returning parsed information correctly
\n

To see the currently supported practice types please see the Practice Type tables.

Medicare
We will return a new object for Medicare called MedicareInfoSummary which will return Medicare specific information such as Part A/B deductible, pharmacy payer name, MCA payer name, and more information. This object will only be returned for Medicare, for all other payers it is null. Please use this object when sending Medicare patients to retrieve Medicare specific information.

Recursive Medicare Advantage Lookup
This will need to be enabled by us, so please contact us at support@pverify.com. When enabled, we will automatically perform a eligibility check (using Eligibility Summary) on selected MCA payers that allow lookup by MBI or Name & DOB. If the can be done, the result is returned in a field RecursiveRequestId.

Thus the workflow is this:

Submit eligibility call to Medicare via Eligibility Summary.
Capture RecursiveRequestId.
Run a GET call (GetEligibilitySummary) using this Id.

Headers

\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n

Key	Value
URL	https://api.pverify.com/API/EligibilitySummary
Method	POST
Headers	Description
Authorization	Authorization token from above preceded by the String \"Bearer\"
Client-API-Id	API ID provided by pVerify
Content-Type	application/json

*Note: The Client-API-Id is required. Header keys are case sensitive.

EligibilitySummary Request Details

Property Name	Data Type	Usage	Description
payerCode	String	Required	pVerify Payer Code(ie Aetna 00001)
payerName	String	Optional	Payer Name
provider.firstName	String	Optional	Provider First Name
provider.middleName	String	Optional	Provider Middle Name
provider.lastName	String	Required	Provider Last Name
provider.npi	String	Required	10-Digit NPI Value
provider.pin	String	Conditional	Required for payer Medi-Cal
provider.taxonomy	String	Optional	Taxonomy
subscriber.firstName	String	Conditional	First Name of subscriber required for self inquiry
subscriber.lastName	String	Conditional	Last Name of subscriber required for self inquiry
subscriber.memberId	String	Required	Member Id required for both type inquiries(self,dependent)
subscriber.dob	String	Conditional	Required for self-inquiry for better matching result. (Expected format: MM/dd/YYYY ie 01/01/2000)
subscriber.ssn	String	Optional	SSN of Subscriber
isSubscriberPatient	String	Required	True for self and False for Dependent Query
doS_StartDate	String	Required	Date of service start date (Expected format: MM/dd/YYYY ie 01/01/2000)
doS_EndDate	String	Required	Date of service end date (Expected format: MM/dd/YYYY ie 01/01/2000)
dependent.patient.firstName	String	Conditional	First Name of dependent
dependent.patient.middleName	String	Optional	Middle Name of dependent
dependent.patient.lastName	String	Conditional	Last Name of dependent
dependent.patient.dob	String	Conditional	Required for dependent inquiry. (Expected format: MM/dd/YYYY ie 01/01/2000)
dependent.patient.gender	String	Optional	Gender of dependent
dependent.relationWithSubscriber	String	Optional	Relation With Subscriber
practiceTypeCode	String	Optional	Please consult Practice Type Code table - sets which practice type to use, i.e. 12 for physical therapy, which will return an object with PT benefits in the results. If you do not select a practice type, the default for your account will be used. Contact pVerify for more info.
includeTextResponse	Boolean	Optional	Indicates whether to return the full text of the eligibility response
referenceId	String	Optional	Patient MRN or account Number
location	String	Required	Location is the practice location. Note by setting this, you will lock the patient to one location, so that users that login in via our portal who are not authorized to see that location will not see the patient.
internalId	String	Optional	Field from customer with their InternalId
customerId	String	Optional	Field from customer with their CustomerId
PlaceOfService	string	optional	Place of service

EligibilitySummary Response Fields

Key	Type	Description
RequestID	Integer	Eligibility Transaction ID
APIResponseCode	String	0-Processed,1-Rejected,2-NoFunds,3-Pending,4-New
APIResponseMessage	String	Message about the transaction
ProcessedWithError	Boolean	true when processed with error by the payer.
EDIErrorMessage	String	Message from Payer about errors
FollowUpAction	String	Response from the Payer
PossibleResolution	String	Suggested steps to be performed before resubmitting to resolve the issue.
PverifyPayerCode	String	pVerify’s Payer Code
ErrorCode	String	It contains unique error Code when Processed with error or Rejected
ErrorDescription	String	It contians description of the error.
PayerName	String	Payer Name as defined by pVerify
VerificationType	String	Verification Type –Subscriber or dependent
IsPayerBackOffice	String	If it is TRUE-NON EDI Payer, FALSE –EDI Payer
DOS	String	Date of service start date – DOS end date
IsHMOPlan	Boolean	If true then Patient has HMO plan
ExceptionNotes	String	Exception Notes if any. If response demographic info is not matched with that of Request
AddtionalInfo	String	If there is any other info
Location	String	Location in which trans ran
ReferrenceId	String	Referencid passed in request
ResultPracticeType	String	Practice type Name
AreAllSTCsProcessed*	Boolean	True when all service codes are processed by payer else false, This is helpful to determine to whether transaction needs to be reverify or not.
STCsStatusMessage*	String	Contains message when AreAllSTCsProcessed=false. Message contains list of not processed service codes
IsProviderInNetwork	Boolean	If true then Provider is InNetwork. Based on Provider Payer Settings* Null, if NO Provider Payer Settings* (*Requires set up in Premium Portal)
RecursiveRequestId	Integer	RequestID of secondary lookup for MCA
RecursiveAPIResponseCode	string	0-Processed,1-Rejected, Status of Secondary Inquiry.
RecursiveAPIResponseMessage	string	Message about the Secondary transaction.
RecursiveProcessedWithError	Bollean	true when Recusrvive transaction Processed with error by the payer.
InternalId	String	Field from customer with their InternalId
CustomerId	String	Field from customer with their CustomerId
Notes	String
DemographicInfo	Object	It contains the subscriber info or dependent info .
ServiceDetails	Object	It contains all Service type details info
PreventiveServices	Object	Contains Preventive codes details
OtherPayerInfo	Object	It contains Other Payer info. It is null then there is no payer change.
PlanCoverageSummary	object	It contains Plan realted info.
PCPAuthInfoSummary	Object	It contains PCP auth info.
HBPC_Deductible_OOP_Summary	Object	It contains Deductible and OOP in from Health benefit Plan Coverage service type .It is null for Medicare Payer Inquiries.
MedicareInfoSummary	Object	It contains Medicare info summary. It is null for other payers and other summary details are empty for Medicare payer transaction.
MiscellaneousInfoSummary	Object
SpecialistOfficeSummary	PracticeTypeSummary	It contains Specialist Consultation specific Summary (Co-Pay,Co-ins,Ded,OOP) and exclusive values of practice type .
DiagnosticLabSummary	PracticeTypeSummary	It contains Diagnostic Lab specific Summary
SurgicalSummary	PracticeTypeSummary	It contains Surgical specific Summary
ASC_FacilitySummary	PracticeTypeSummary	It contains Ambulatory Service Center Facility specific Summary
OncologySummary	PracticeTypeSummary	It contains Oncology specific Summary
DMESummary	PracticeTypeSummary	It contains Durable Medical Equipment specific Summary
MentalHealthSummary	VisitLimitationsSummary	It contains Mental Health specific Summary
PrimaryCareSummary	PracticeTypeSummary	It contains Primary Care specific Summary
MRI_CT_ScanSummary	PracticeTypeSummary	It contains MRI, CAT Scan specific Summary
UrgentCareSummary	PracticeTypeSummary	It contains Urgent Care specific Summary
XRaySummary	PracticeTypeSummary	It contains X Ray specific Summary
VisionOptometrySummary	OpthalmologySummary	It contains Opthalmology (Vision) specific Summary
PhysicalTherapySummary	TherapySummary	It contains Physical Therapy specific Summary
ChiropracticSummary	TherapySummary	It contains Chiropractice specific Summary
SpeechThearySummary	TherapySummary	It contains Speech Therapy specific Summary
OccupationalTherapySummary	TherapySummary	It contains Occupational Therapy specific Summary
EmergencyMedicalSummary	PracticeTypeSummary	It contains Emergency Medical specific Summary
WellnessOrRoutineVisitSummary	VisitLimitationsSummary	It contains Wellness Or Routine Visit specific Summary
PodiatryOfficeSummary	PracticeTypeSummary	It contains Podiatry Office specific Summary
AnesthesiaSummary	PracticeTypeSummary	It contains Anesthesia specific Summary
SubstanceAbuseProfessionalSummary	PracticeTypeSummary	It contains Substance Abuse Professional specific Summary
SubstanceAbuseInPatientFacilitySummary	PracticeTypeSummary	It contains Substance Abuse InPatient Facility specific Summary
SubstanceAbuseOutPatientFacilitySummary	PracticeTypeSummary	It contains Substance Abuse OutPatient Facility specific Summary
TelemedicineSummary	PracticeTypeSummary	It contains Telemedicine specific Summary
FluVaccinationSummary	PracticeTypeSummary	It contains FluVaccination specific Summary
HospitalInpatientSummary	PracticeTypeSummary	It contains Hospital Inpatient specific Summary
HospitalOutPatientSummary	PracticeTypeSummary	It contains Hospital Outpatient specific Summary
PharmacySummary	PracticeTypeSummary	It contains Pharmacy specific Summary
TelemedicinePrimaryCareSummary	PracticeTypeSummary	It contains Telemedicine Primary specific Summary
TelemedicineSpecialistSummary	PracticeTypeSummary	It contains Telemedicine Specialist specific Summary
TelemedicineUrgentCareSummary	PracticeTypeSummary	It contains Telemedicine Urgent Care specific Summary
TelemedicineMentalHealthSummary	VisitLimitationsSummary	It contains Telemedicine Mental Health specific Summary
TelemedicinePhysicalTherapySummary	TherapySummary	It contains Telemedicine Physical Therapy specific Summary
PsychotherapySummary	VisitLimitationsSummary	It contains Psychotherapy specific Summary
SNFSummary	PracticeTypeSummary	It contains SNF specific summary
SNFRoomBoardSummary	PracticeTypeSummary	It contains SNF and Board specific summary
ProfessionalPhysicianVisitInpatientSummary	PracticeTypeSummary	It contains Professional Physician Visit Inpatient specific summary
HospiceSummary	PracticeTypeSummary	It contains Hospice specific summary
HomeHealthCareSummary	DaysLimitationsSummary	It contains Home Health Care specific summary. It has more keys than normal practice type.
AllergiesSummary	PracticeTypeSummary	It contains Allergies specific summary
DiagnosticMedicalSummary	PracticeTypeSummary	It contains Diagnostic Medical specific summary
MaternitySummary	PracticeTypeSummary	It contains Maternity specific summary
ImmunizationsSummary	PracticeTypeSummary	It contians Immunizations specific summary
TelemedicineOccupationalTherapySummary	TherapySummary	It contains Telemedicine details for Occupational therapy
TelemedicineSpeechTherapySummary	TherapySummary	It contains Telemedicine details for Speech Therapy
EligibilityResult	string	It contains results in formatted text
DetailsURL	string	URL for the full report

","urlObject":{"protocol":"https","path":["api","EligibilitySummary"],"host":["api","pverify","com"],"query":[],"variable":[]}},"response":[],"_postman_id":"b618599e-5e2a-407e-b61e-ecb37bc7e0c9"},{"name":"GetEligibilitySummary","id":"f91239c0-309c-4547-8cfc-90c67795e9c5","protocolProfileBehavior":{"disableBodyPruning":true},"request":{"method":"GET","header":[{"key":"Authorization","type":"text","value":"Bearer {{access-token}}"},{"key":"Client-API-Id","type":"text","value":"{{client-api-id}}"},{"key":"Content-Type","type":"text","value":"application/json"}],"url":"https://api.pverify.com/API/GetEligibilitySummary/9882795","description":"

\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n

Environment	URL
Test	https://testapi.pverify.com/API/GetEligibilitySummary
Production	https://api.pverify.com/API/GetEligibilitySummary

GetEligibilitySummary returns the response from the EligibilitySummary POST call using a unique request id provided in the EligibilitySummary response. EligibilitySummary is not supported for back office payers.

Headers

\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n

Key	Value
URL	https://api.pverify.com/API/GetEligibilitySummary
Method	GET
Headers	Description
Authorization	Authorization token from above preceded by the String \"Bearer\"
Client-API-Id*	Your pVerify client-api-id
Client-API-Id	API ID provided by pVerify
Content-Type	application/json
URL Parameters	RequestId returned in EligibilitySummary response

*Note: The Client-API-Id header is required. Header keys are case sensitive.

GetEligibilitySummary Response Fields

See EligibilitySummary response.

\n","urlObject":{"protocol":"https","path":["API","GetEligibilitySummary","9882795"],"host":["api","pverify","com"],"query":[],"variable":[]}},"response":[],"_postman_id":"f91239c0-309c-4547-8cfc-90c67795e9c5"},{"name":"EligibilityInquiry","id":"775a7ec0-59f8-42b1-a6d5-c2401bd5fbd3","protocolProfileBehavior":{"disableBodyPruning":true},"request":{"method":"POST","header":[{"key":"Authorization","value":"Bearer {{access-token}}"},{"key":"Client-API-Id","value":"{{client-api-id}}"},{"key":"Content-Type","value":"application/json"}],"body":{"mode":"raw","raw":"{\n \"payerCode\": \"00007\",\n \"provider\": {\n \"firstName\": \"\",\n \"middleName\": \"\",\n \"lastName\": \" test name\",\n \"npi\": \"1122334455\",\n \"pin\":\"00000\"\n },\n \"subscriber\": {\n \"firstName\": \"first\",\n \"middleName\": \"\",\n \"lastName\": \"somelast\",\n \"dob\": \"12/21/2018\",\n \"memberID\": \"1234567890\"\n },\n \"dependent\": {\n \"patient\": {\n \"firstName\": \"\",\n \"middleName\": \"\",\n \"lastName\": \"\",\n \"dob\": \"\",\n \"gender\": \"\"\n },\n \"relationWithSubscriber\": \"\"\n },\n \"isSubscriberPatient\": \"true\",\n \"doS_StartDate\": \"12/21/2018\",\n \"doS_EndDate\": \"12/21/2018\",\n \"serviceCodes\": [\n \"30\"\n ],\n \"IncludeTextResponse\": true,\n \"referenceId\": \"1234\",\n \"Location\": \"Nowhere\",\n \"InternalId\":\"\",\n \"CustomerID\":\"\",\n \"PlaceOfService\":\"01\"\n}"},"url":"https://api.pverify.com/API/EligibilityInquiry","description":"

\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n

Environment	URL
Test	https://testapi.pverify.com/API/EligibilityInquiry
Production	https://api.pverify.com/API/EligibilityInquiry

The EligibilityInquiry endpoint is the main method used get an eligibility report for a specific subscriber / dependent. This requires customers to post a request, via REST to a designated URL address. Once a request is received by the service an immediate response is sent for each request posted. To use this or any other method, you must first generate a token via the Token endpoint (see above Token method).

Payers return many formats for the eligibility report, which we parse to put into a JSON object format. Critical to the successful parsing of this information is the concept of our pVerify exclusive payer and client specific parsing logic, stored in NetworkSections in the response. See below for more information.

An example of a successful authorization response can be found in the code to the right. Please note you MUST use the pVerify payerCode. We also recommend passing the payer name.

Also note the body of the EligibilityInquiry is populated differently depending on if it is a subscriber query or a dependent query. See examples to the right.

EligibilityInquiry Request

\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n

Type	Description
URL	https://api.pverify.com/API/EligibilityInquiry
Method	POST
Headers	Description
Authorization	Token from Step 1 Above (if you are using Postman be sure to put Token Type Bearer before the token.)
Client-API-Id*	client-api-id from step one
Content-Type	application/json
Body	Description
Data Params	See below and examples to the right

*Note: The Client-API-Id header is required. Header keys are case sensitive.

EligibilityInquiry Request Object

See subscriber and dependent examples to the right

EligibilityInquiry Request Fields

Property Name	Data Type	Usage	Description
payerCode	String	Required	pVerify Payer Code(ie Aetna 00001)
payerName	String	Optional	Payer Name
provider.firstName	String	Optional	Provider First Name
provider.middleName	String	Optional	Provider Middle Name
provider.lastName	String	Required	Provider Last Name
provider.npi	String	Required	10-Digit NPI Value
provider.pin	String	Conditional	Required for payer Medi-Cal
provider.taxonomy	String	Optional	Taxonomy
subscriber.firstName	String	Conditional	First Name of subscriber required for self inquiry
subscriber.lastName	String	Conditional	Last Name of subscriber required for self inquiry
subscriber.memberId	String	Required	Member Id required for both type inquiries(self,dependent)
subscriber.dob	String	Conditional	Required for self-inquiry for better matching result. (Expected format: MM/dd/YYYY ie 01/01/2000)
subscriber.ssn	String	Optional	SSN of Subscriber
isSubscriberPatient	String	Required	True for self and False for Dependent Query
doS_StartDate	String	Required	Date of service start date (Expected format: MM/dd/YYYY ie 01/01/2000)
doS_EndDate	String	Required	Date of service end date (Expected format: MM/dd/YYYY ie 01/01/2000)
serviceCodes	String Array	Required	Services codes to run inquiry. If no service codes are passed then service code 30 will be assigned.
dependent.patient.firstName	String	Conditional	First Name of dependent
dependent.patient.middleName	String	Optional	Middle Name of dependent
dependent.patient.lastName	String	Conditional	Last Name of dependent
dependent.patient.dob	String	Conditional	Required for dependent inquiry. (Expected format: MM/dd/YYYY ie 01/01/2000)
dependent.patient.gender	String	Optional	Gender of dependent
dependent.relationWithSubscriber	String	Optional	Relation With Subscriber
includeTextResponse	Boolean	Optional	Indicates whether to return the full text of the eligibility response
referenceId	String	Required	Patient MRN or account Number
location	String	Required	Location is the practice location. Note by setting this, you will lock the patient to one location, so that users that login in via our portal who are not authorized to see that location will not see the patient.
internalId	String	Optional	Field from customer with their InternalId
customerId	String	Optional	Field from customer with their CustomerId
PlaceOfService	String	Optional	Field from customer with their PlaceOfService

EligibilityInquiry Response Fields

Name	Type	Description
ElgRequestID	int	Identification of Eligibility Request
Status	String	The eligibility status (active or inactive)
PayerName	String	Name of company satisfying the claim
payerCode	String	pVerify Payer Code
VerificationType	String	Specifies whether the patient verification was a Subscriber Verification or a Dependent Verification
isPayerBackOffice	boolean	False - Non-EDI payer. True - EDI Payer
verificationStatus	String	Status of the verification - Processed, pending, etc - See Table below
verificationMessage	String	Message from Backoffice
ProcessedWithError	Boolean	true when processed with error by the payer.
DOS	String	Date of Service (Expected format: MM/dd/YYYY ie 01/01/2000)
Plan	String	Denotes the health care plan that the individual has
ExceptionNotes	String	Notes concerning exceptions to the above fields
AdditionalInformation	String	Any further information
EDIErrorMessage	String	Error message from clearinghouse
FollowUpAction	String	Response from the Payer
PossibleResolution	String	Suggested steps to be performed before resubmitting to resolve the issue.
ErrorCode	String	It contains unique error code.
ErrorDescription	String	It contains error description.
OtherMessage	String	Processing message - ie Allowed, insufficient Funds
reportURL	String	URL for the full eligibility report (via pVerify portal)
doB_R	String	Date of Birth (Expected format: MM/dd/YYYY ie 01/01/2000)
eligibilityPeriod	Object	Eligibility dates
eligibilityPeriod.effectiveFromDate	String	Date the coverage is effective from
eligibilityPeriod.expiredOnDate	String	Date coverage expired
DemographicInfo	Object	Demographics
DemographicInfo.Subscriber	Object	Subscriber demographics
DemographicInfo.Subscriber.Address1	String	Subscriber Address1
DemographicInfo.Subscriber.Address2	String	Subscriber Address2
DemographicInfo.Subscriber.City	String	Subscriber City
DemographicInfo.Subscriber.State	String	Subscriber state
DemographicInfo.Subscriber.Zip	String	Subscriber zip code
DemographicInfo.Subscriber.DOB_R	String	Subscriber Date of Birth (Expected format: MM/dd/YYYY ie 01/01/2000)
DemographicInfo.Subscriber.Firstname	String	Subscriber first name
DemographicInfo.Subscriber.Lastname_R	String	Subscriber last name
DemographicInfo.Subscriber.Gender_R	String	Subscriber gender
DemographicInfo.Subscriber. Identification	Object	Has member ID, group #, group name
DemographicInfo.Subscriber. Identification.Code	String	ie: \"JOHN\"
DemographicInfo.Subscriber. Identification.Type	String	ie: \"FirstName\"
DemographicInfo.Subscriber. Identification.Name	String	Name of identification
DemographicInfo.Dependent	Object	Dependent Demographics (See subscriber for fields common to both)
relationship	String	Dependent relationship to client
NetworkSections	Object	Contains copay, deductible, etc. Based on custom result field settings (per payer)
NetworkSections.identifier	String	ie: \"Deductible\"
NetworkSections.label	String	ie: \"Deductible\"
NetworkSections.inNetworkParameters	Object	In network details = Deductible, outofPocket, Copay, Coins
NetworkSections.inNetworkParameters.key	String	ie: \"Annual\" (Annual Deductible)
NetworkSections.inNetworkParameters.value	String	ie: \"600.00\"
HealthBenefitPlanCoverageServiceType	Object	From eligibility response from clearinghouse, will contain string data with copay, etc.
HealthBenefitPlanCoverageServiceType. serviceTypeName	String	ie: \"Health Benefit Plan Coverage\"
HealthBenefitPlanCoverageServiceType. serviceTypeSections	Array	List of service type info
HealthBenefitPlanCoverageServiceType. serviceTypeSections.label	String	ie: \"In Plan-Network Status\"
HealthBenefitPlanCoverageServiceType. serviceTypeSections.serviceParameters	Object	Service Parameters
HealthBenefitPlanCoverageServiceType. serviceTypeSections.serviceParameters.key	String	Description of field ie Family Calendar Year Deductible
HealthBenefitPlanCoverageServiceType. serviceTypeSections.serviceParameters.value	String	Value of field (note most payers are passing info via message, below) ie 1800.00
HealthBenefitPlanCoverageServiceType. serviceTypeSections.serviceParameters.message	String	Description of value ie (\"MED DENT,MAXIMUM SAVINGS\")
HealthBenefitPlanCoverageServiceType. serviceTypeSections.serviceParameters.otherInfo	Array	More details about the key - in key/value/message/otherInfo
ServiceTypes	Object	Full list of returned service types from clearinghouse
ServiceTypeName	String	ie Chiropractic
ServiceTypeSection	Object	data regarding service type coverage in key/value/message/otherInfo
isHMOPlan	boolean	True of plan type is known to be HMO
InternalId	String	Field from customer with their InternalId
CustomerId	String	Field from customer with their CustomerId
DetailsURL	string	URL for the full report
IsProviderInNetwork	Bollean	Nullable Boolean value type.If true then Provider is InNetwork. Based on Provider Payer Settings* Null, if NO Provider Payer Settings* (*Requires set up in Premium Portal)
RecursiveRequestId	Integer	Recursive tran Request Id
RecursiveAPIResponseCode	string	0-Processed,1-Rejected, Status of Secondary Inquiry.
RecursiveAPIResponseMessage	string	Message about the secondary transaction.

EligibilityInquiry returns verificationStatus which is the status of the inquiry (not the status of the patients eligibility, which is the Status field) according to the table below:

\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n

Status Text	Meaning
Processed	We received a valid response from the clearinghouse
Rejected	The transaction is rejected due to bad data (ie: missing memberId)
Pending+	The transaction is for back office payer and has been queued
Canceled	The transaction has been canceled via API endpoint

+: Status Code 15 Pending is returned when the payer is non-EDI -- pVerify uses manual process (phone/web-login) to get results or in some cases uses screen scraping technology to fetch the eligibility and benefits for such payers -- the delay in getting the results can be anywhere from 1 min. to 12 hours based on payer and agreed terms. These \"Delayed Payers\" have prefix of either BO or PL, you can either automatically refresh results using the Unique ID every few hours or have a \"Get Pending Results\" button on your eligibility screen.

Parsing the Key Eligibility Fields
As the response object is complex, below is a guide to where the key eligibility fields are.

Demographics
This is in demographicInfo.subscriber. For example, the first name of the subscriber is demographicInfo.subscriber.firstname

Copay/Coinsurance:
The copay and coinsurance depends on the service type. For physician office visits, it may be in network section (see below for more information), and will be in the physician office visit area.

\n","urlObject":{"protocol":"https","path":["API","EligibilityInquiry"],"host":["api","pverify","com"],"query":[],"variable":[]}},"response":[],"_postman_id":"775a7ec0-59f8-42b1-a6d5-c2401bd5fbd3"},{"name":"GetEligibilityResponse","id":"6f9910dd-1b83-4fc9-ad9c-f5b2a4b09ec8","protocolProfileBehavior":{"disableBodyPruning":true},"request":{"method":"GET","header":[{"key":"Authorization","value":"Bearer {{access-token}}"},{"key":"Client-API-Id","value":"{{client-api-id}}"},{"key":"Content-Type","value":"application/json"}],"url":"https://api.pverify.com/API/GetEligibilityResponse/2428","description":"

\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n

Environment	URL
Test	https://testapi.pverify.com/API/GetEligibilityResponse/{id}
Production	https://api.pverify.com/API/GetEligibilityResponse/{id}

This GET method is similar to the Eligibility Inquiry except that it is a GET call with the Eligibility Request ID as a parameter. This call allows you to get the eligibility verification result by a unique transaction ID. It is designed for use with non-EDI (back office) payers which require human intervention and are thus time delayed in the response.

GetEligibilityResponse Request

\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n

Key	Value
URL	https://api.pverify.com/API/GetEligibilityResponse/{id}
Method	GET
Headers	Description
Authorization	Authorization token from above preceded by the String \"Bearer\"
Client-API-Id*	Your pVerify client-api-id

*Note: The Client-API-Id header is required. Header keys are case sensitive.

A successful GetEligibilityResponse call will have the same format as the Eligibility Inquiry response (above). In the case of backoffice payer, many sections will be null including Demographic Info and HealthBenefitPlanCoverageServiceType. The important data returned (copay, coins, etc) is typically in the NetworkSections object, and IsPayerBackOffice is always true. In the case of electronic payers the response object (format and data) is identical to that of EligibilityInquiry.

\n","urlObject":{"protocol":"https","path":["API","GetEligibilityResponse","2428"],"host":["api","pverify","com"],"query":[],"variable":[]}},"response":[],"_postman_id":"6f9910dd-1b83-4fc9-ad9c-f5b2a4b09ec8"},{"name":"GetEligibility271","id":"31b0db46-334f-4ffa-bb0a-3f084efe6b2f","protocolProfileBehavior":{"disableBodyPruning":true},"request":{"auth":{"type":"noauth","isInherited":false},"method":"GET","header":[{"key":"Authorization","value":"Bearer {{access-token}}"},{"key":"Client-API-Id","value":"{{client-api-id}}"},{"key":"Content-Type","value":"application/json"}],"url":"https://api.pverify.com/API/GetEligibility271/1111","description":"

\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n

Environment	URL
Test	https://testapi.pverify.com/API/GetEligibility271/{id}
Production	https://api.pverify.com/API/GetEligibility271/{id}

This GET method will return EDI 271 Raw response with Eligibility Request ID as a parameter.

GetEligibility271 Request

\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n

Key	Value
URL	https://api.pverify.com/API/GetEligibility271/{id}
Method	GET
Headers	Description
Authorization	Authorization token from above preceded by the String \"Bearer\"
Client-API-Id*	Your pVerify client-api-id

*Note: The Client-API-Id header is required. Header keys are case sensitive.

GetEligibility271 Response

\n\n\n\n\n\n\n\n\n\n\n\n\n

Key	Value
EDI271ANSI	ANSI String for request or Error Message

","urlObject":{"protocol":"https","path":["API","GetEligibility271","1111"],"host":["api","pverify","com"],"query":[],"variable":[]}},"response":[],"_postman_id":"31b0db46-334f-4ffa-bb0a-3f084efe6b2f"},{"name":"EasyEligibility","id":"e16e77c0-c5d9-4fa0-8928-784a639244f4","protocolProfileBehavior":{"disableBodyPruning":true},"request":{"method":"POST","header":[{"key":"Client-API-Id","value":"{{client-api-id}}","type":"text"},{"key":"Client-Secret","value":"{{client-secret}}","type":"text"},{"key":"Content-Type","value":"application/json","type":"text"}],"body":{"mode":"raw","raw":"{\r\n\t\"payerCode\": \"00001\",\r\n\t\"provider_lastname\": \"test\",\r\n\t\"provider_npi\": \"1234567890\",\r\n \"Provider_PIN\":\"00000\",\r\n\t\"memberID\": \"123456789A\",\r\n\t\"patient_DOB\": \"10/02/2010\",\r\n\t\"patient_first\": \"John\",\r\n\t\"patient_last\": \"Deo\",\r\n\t\"date_Of_Service\": \"07/17/2020\",\r\n\t\"serviceCodes\": \"30\",\r\n\t\"referenceId\": \"\",\r\n\t\"location\": \"\",\r\n \"InternalId\":\"\",\r\n \"CustomerID\":\"\"\r\n}"},"url":"https://api.pverify.com/API/EasyEligibility","description":"

\n\n\n\n\n\n\n\n\n\n\n\n\n

Environment	URL
Production	https://api.pverify.com/api/EasyEligibility

This POST call will return the Eligibility Status of a requested provider. The EasyEligibility endpoint is designed to facilitate easy access to Eligibility Information in just one step.

\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n

Key	Value
URL	https://api.pverify.com/api/EasyEligibility
Method	POST
Header	Description
Client-API-Id*	Your pVerify client-api-id
Body	See the data parameters to the right

*Note: The Client-API-Id header is required. Header keys are case sensitive.

EasyEligibility Request Fields

\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n

Field	Type	Usage	Description
payerCode	String	Required	pVerify payer code
provider_lastname	String	Required	Provider Last Name
provider_npi	String	Required	NPI number of provider
Provider_PIN	String	Conditional	Provider PIN
Provider_TaxId	String	Conditional	Provider TaxId
Patient_First	String	Conditional	Patient First Name
Patient_Last	String	Conditional	Patient Last Name
memberID	String	Conditional	Payer Member ID
patient_DOB	String	Conditional	Patient date of birth (Expected format: MM/dd/YYYY ie 01/01/2000)
date_Of_Service	String	Required	Date of Service (Expected format: MM/dd/YYYY ie 01/01/2000)
Date_Of_Service_To	String	Optional	Date of Service To (in format MM-DD-YYYY). Default date is Date of Service Start date
serviceCodes	String	Optional	If no STC passed then STC 30 will be used
InternalId	String	Optional	Field from customer with their InternalId
CustomerId	String	Optional	Field from customer with their CustomerId

EasyEligibility Response

\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n

Field	Type	Description
transactionStatus	String	Status of transaction
transactionMessage	String	Additional information regarding transaction
ediErrorMessage	String	Error message
FollowUpAction	String	Response from the Payer
PossibleResolution	String	Suggested steps to be performed before resubmitting to resolve the issue.
processedWithError	Boolean	true when processed with error by the payer.
eligibilityStatus	String	Status of eligibility
eligibilityResult	String	Final information regarding eligibility
referenceId	String	Patient MRN or account Number
location	String	Location is the practice location. Note by setting this, you will lock the patient to one location, so that users that login in via our portal who are not authorized to see that location will not see the patient.
InternalId	String	Field from customer with their InternalId
CustomerId	String	Field from customer with their CustomerId
RecursiveRequestId	Interger	RequestID of secondary lookup for MCA
RecursiveAPIResponseCode	String	0-Processed,1-Rejected, Status of Secondary Inquiry.
RecursiveAPIResponseMessage	String	Message about the Secondary transaction.
DetailsURL	string	URL for the full report

","urlObject":{"protocol":"https","path":["API","EasyEligibility"],"host":["api","pverify","com"],"query":[],"variable":[]}},"response":[],"_postman_id":"e16e77c0-c5d9-4fa0-8928-784a639244f4"},{"name":"EasyEligibilitySummary","id":"c7e02c3a-a5ff-41b0-b6e1-4712b7fb8acf","protocolProfileBehavior":{"disableBodyPruning":true},"request":{"method":"POST","header":[{"key":"Client-API-Id","type":"text","value":"{{client-api-id}}"},{"key":"Client-Secret","type":"text","value":"{{client-secret}}"},{"key":"Content-Type","type":"text","value":"application/json"}],"body":{"mode":"raw","raw":"{\r\n\t\"payerCode\": \"00001\",\r\n\t\"payerName\": \"Aetna\",\r\n\t\"Provider_LastName\": \"SAM MD\",\r\n\t\"Provider_NPI\": \"1234567890\",\r\n \"Provider_PIN\":\"00000\",\r\n\t\"Patient_First\": \"John\",\r\n\t\"Patient_DOB\": \"10/02/2010\",\r\n\t\"Patient_Last\": \"Deo\",\r\n\t\"memberID\": \"123456789A\",\r\n\t\"Date_Of_Service\": \"07/17/2020\",\r\n\t\"referenceId\": \"\",\r\n\t\"Location\": \"\",\r\n\t\"PracticeTypeCode\": \"18\",\r\n\t\"IncludeTextResponse\": false,\r\n \"InternalId\":\"\",\r\n \"CustomerID\":\"\"\r\n}","options":{"raw":{"language":"json"}}},"url":"https://api.pverify.com/API/EasyEligibilitySummary","description":"

\n\n\n\n\n\n\n\n\n\n\n\n\n

Environment	URL
Production	https://api.pverify.com/API/EasyEligibilitySummary

The Easy Eligibility Summary call is intended to generate an Eligibility Summary Response in just one step. With EasyEligibilitySummary, simply pass your credentials (no need to generate a token) and the body parameters (specified below) to return an Eligibility Summary Response in just one step.

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Key	Value
URL	https://api.pverify.com/API/EasyEligibilitySummary
Method	POST
Header	Description
Client-API-Id	pVerify client-api-id
Client-Secret	pVerify client-secret
Content-Type	application/json
Body	See below

EasyEligibilitySummary Request Fields

Field	Type	Usage	Description
payerCode	String	Required	Payer Code
payerName	String	Optional	PayerName
Provider_LastName	String	Required	Provider last name
Provider_NPI	String	Required	Provider NPI
Provider_PIN	String	Conditional	Provider PIN
Provider_TaxId	String	Conditional	Provider TaxId
Patient_First	String	Conditional	Patient First Name
Patient_DOB	String	Conditional	Patient Date of Birth (in format MM-DD-YYYY)
Patient_Last	String	Conditional	Patient Last Name
memberID	String	Conditional	Member ID
Date_Of_Service	String	Required	Date of Service (in format MM-DD-YYYY)
Date_Of_Service_To	String	Optional	Date of Service To (in format MM-DD-YYYY). Default date is Date of Service Start date
referenceId	String	Optional	Patient MRN or account Number
Location	String	Optional	Location is the practice location. Note by setting this, you will lock the patient to one location, so that users that login in via our portal who are not authorized to see that location will not see the patient.
PracticeTypeCode	String	Optional	Please consult Practice Type Code table - sets which practice type to use, i.e. 12 for physical therapy, which will return an object with PT benefits in the results. If you do not select a practice type, the default for your account will be used. Contact pVerify for more info.
IncludeTextResponse	Boolean	Optional	Boolean value to determine if text response should be included
InternalId	String	Optional	No
CustomerId	String	Optional	No

EasyEligibilitySummary Response Fields

Key	Type	Description
RequestID	Integer	Eligibility Transaction ID
APIResponseCode	String	0-Processed,1-Rejected,2-NoFunds,3-Pending,4-New
APIResponseMessage	String	Message about the transaction
ProcessedWithError	Boolean	true when processed with error by the payer.
EDIErrorMessage	String	Message from Payer about errors
FollowUpAction	String	Response from the Payer
PossibleResolution	String	Suggested steps to be performed before resubmitting to resolve the issue.
PverifyPayerCode	String	pVerify’s Payer Code
PayerName	String	Payer Name as defined by pVerify
VerificationType	String	Verification Type –Subscriber or dependent
IsPayerBackOffice	String	If it is TRUE-NON EDI Payer, FALSE –EDI Payer
VerificationStatus	String	Eligibility Transaction Status- Values : Processed, Pending, Rejected
DOS	String	Date of service start date – DOS end date
Is HMO Plan	Boolean	If true then Patient has HMO plan
ExceptionNotes	String	Exception Notes if any. If response demographic info is not matched with that of Request
AddtionalInfo	String	If there is any other info
Location	String	Location in which trans ran
ReferrenceId	String	Referencid passed in request
ResultPracticeType	String	Practice type Name
AreAllSTCsProcessed*	Boolean	True when all service codes are processed by payer else false, This is helpful to determine to whether transaction needs to be reverify or not.
STCsStatusMessage*	String	Contains message when AreAllSTCsProcessed=false. Message contains list of not processed service codes
IsProviderInNetwork	Boolean	If true then Provider is InNetwork. Based on Provider Payer Settings* Null, if NO Provider Payer Settings* (*Requires set up in Premium Portal)
RecursiveRequestId	Integer	RequestID of secondary lookup for MCA
RecursiveAPIResponseCode	String	0-Processed,1-Rejected, Status of Recursive Inquiry.
RecursiveAPIResponseMessage	String	Message about the Recursive transaction.
InternalId	String	Field from customer with their InternalId
CustomerId	String	Field from customer with their CustomerId
Notes	String
DemographicInfo	Object	It contains the subscriber info or dependent info .
ServiceDetails	Object	It contains all Service type details info
PreventiveServices	Object	Contains Preventive codes details
OtherPayerInfo	Object	It contains Other Payer info. It is null then there is no payer change.
PlanCoverageSummary	object	It contains Plan realted info.
PCPAuthInfoSummary	Object	It contains PCP auth info.
HBPC_Deductible_OOP_Summary	Object	It contains Deductible and OOP in from Health benefit Plan Coverage service type .It is null for Medicare Payer Inquiries.
MedicareInfoSummary	Object	It contains Medicare info summary. It is null for other payers and other summary details are empty for Medicare payer transaction.
MiscellaneousInfoSummary	Object
SpecialistOfficeSummary	PracticeTypeSummary	It contains Specialist Consultation specific Summary (Co-Pay,Co-ins,Ded,OOP) and exclusive values of practice type .
DiagnosticLabSummary	PracticeTypeSummary	It contains Diagnostic Lab specific Summary
SurgicalSummary	PracticeTypeSummary	It contains Surgical specific Summary
ASC_FacilitySummary	PracticeTypeSummary	It contains Ambulatory Service Center Facility specific Summary
OncologySummary	PracticeTypeSummary	It contains Oncology specific Summary
DMESummary	PracticeTypeSummary	It contains Durable Medical Equipment specific Summary
MentalHealthSummary	PracticeTypeSummary	It contains Mental Health specific Summary
PrimaryCareSummary	PracticeTypeSummary	It contains Primary Care specific Summary
MRI_CT_ScanSummary	PracticeTypeSummary	It contains MRI, CAT Scan specific Summary
UrgentCareSummary	PracticeTypeSummary	It contains Urgent Care specific Summary
XRaySummary	PracticeTypeSummary	It contains X Ray specific Summary
VisionOptometrySummary	OpthalmologySummary	It contains Opthalmology (Vision) specific Summary
PhysicalTherapySummary	TherapySummary	It contains Physical Therapy specific Summary
ChiropracticSummary	TherapySummary	It contains Chiropractice specific Summary
SpeechThearySummary	TherapySummary	It contains Speech Therapy specific Summary
OccupationalTherapySummary	TherapySummary	It contains Occupational Therapy specific Summary
EmergencyMedicalSummary	PracticeTypeSummary	It contains Emergency Medical specific Summary
WellnessOrRoutineVisitSummary	PracticeTypeSummary	It contains Wellness Or Routine Visit specific Summary
PodiatryOfficeSummary	PracticeTypeSummary	It contains Podiatry Office specific Summary
AnesthesiaSummary	PracticeTypeSummary	It contains Anesthesia specific Summary
SubstanceAbuseProfessionalSummary	PracticeTypeSummary	It contains Substance Abuse Professional specific Summary
SubstanceAbuseInPatientFacilitySummary	PracticeTypeSummary	It contains Substance Abuse InPatient Facility specific Summary
SubstanceAbuseOutPatientFacilitySummary	PracticeTypeSummary	It contains Substance Abuse OutPatient Facility specific Summary
TelemedicineSummary	PracticeTypeSummary	It contains Telemedicine specific Summary
FluVaccinationSummary	PracticeTypeSummary	It contains FluVaccination specific Summary
HospitalInpatientSummary	PracticeTypeSummary	It contains Hospital Inpatient specific Summary
HospitalOutPatientSummary	PracticeTypeSummary	It contains Hospital Outpatient specific Summary
PharmacySummary	PracticeTypeSummary	It contains Pharmacy specific Summary
TelemedicinePrimaryCareSummary	PracticeTypeSummary	It contains Telemedicine Primary specific Summary
TelemedicineSpecialistSummary	PracticeTypeSummary	It contains Telemedicine Specialist specific Summary
TelemedicineUrgentCareSummary	PracticeTypeSummary	It contains Telemedicine Urgent Care specific Summary
TelemedicineMentalHealthSummary	PracticeTypeSummary	It contains Telemedicine Mental Health specific Summary
TelemedicinePhysicalTherapySummary	TherapySummary	It contains Telemedicine Physical Therapy specific Summary
PsychotherapySummary	PracticeTypeSummary	It contains Psychotherapy specific Summary
EligibilityResult	string	It contains results in formatted text
DetailsURL	string	URL for the full report

","urlObject":{"protocol":"https","path":["API","EasyEligibilitySummary"],"host":["api","pverify","com"],"query":[],"variable":[]}},"response":[],"_postman_id":"c7e02c3a-a5ff-41b0-b6e1-4712b7fb8acf"},{"name":"GetPendingInquiries","id":"9708c8f4-b7af-423f-9f7f-fa8ab05a9e2b","protocolProfileBehavior":{"disableBodyPruning":true},"request":{"method":"GET","header":[{"key":"Authorization","value":"Bearer {{access-token}}"},{"key":"Client-API-Id","value":"{{client-api-id}}"},{"key":"Content-Type","value":"application/json"}],"url":"https://api.pverify.com/API/GetPendingInquiries?DOS=01-01-2018","description":"

\n\n\n\n\n\n\n\n\n\n\n\n\n

Environment	URL
Production	https://api.pverify.com/API/GetPendingInquiries?DOS=01-01-2018

This endpoint will retrieve a list of pending transactions. It is intended to show which back office eligibility transactions are not complete yet, given the DOS as an input.

GetPendingInquiries Request

\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n

Key	Value
URL	https://api.pverify.com/API/GetPendingInquiries?DOS=01-01-2018
Method	GET
Headers	Description
Authorization	Authorization token from above preceded by the String \"Bearer\"
Client-API-Id	Your pVerify client-api-id
URL Parameters	Date of Service (format is MM-DD-YYYY)

","urlObject":{"protocol":"https","path":["API","GetPendingInquiries"],"host":["api","pverify","com"],"query":[{"key":"DOS","value":"01-01-2018"}],"variable":[]}},"response":[],"_postman_id":"9708c8f4-b7af-423f-9f7f-fa8ab05a9e2b"},{"name":"CancelTransaction","id":"6c6d5192-279f-4a19-ae56-7d05ce901c4b","protocolProfileBehavior":{"disableBodyPruning":true},"request":{"method":"POST","header":[{"key":"Authorization","value":"Bearer {{access-token}}"},{"key":"Client-API-Id","value":"{{client-api-id}}"},{"key":"Content-Type","value":"application/json"}],"body":{"mode":"raw","raw":"{\r\n\"transactionId\":12345455\r\n}"},"url":"https://api.pverify.com/API/CancelTransaction","description":"

\n\n\n\n\n\n\n\n\n\n\n\n\n

Environment	URL
Production	https://api.pverify.com/API/CancelTransaction

This POST call will cancel a transaction. It is intended for use with back office transactions, to cancel a transaction that is not able to be completed in time for the patients visit.

CancelTransaction Request

\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n

Key	Value
URL	https://api.pverify.com/API/CancelTransaction
Method	POST
Headers	Description
Authorization	Authorization token from above preceded by the String \"Bearer\"
Client-API-Id*	pVerify client-api-id
Content-Type	application/json
Body	Description
transactionId	Transaction ID for transaction you wish to cancel

*Note: The Client-API-Id is required in header. Header keys are case sensitive.

\n","urlObject":{"protocol":"https","path":["API","CancelTransaction"],"host":["api","pverify","com"],"query":[],"variable":[]}},"response":[],"_postman_id":"6c6d5192-279f-4a19-ae56-7d05ce901c4b"},{"name":"EligibilityPDFReport","id":"ec730ff0-34aa-4056-a99c-4f791fd6008b","protocolProfileBehavior":{"disableBodyPruning":true},"request":{"method":"GET","header":[{"key":"Client-API-Id","value":"{{client-api-id}}"},{"key":"Client-Secret","value":"{{client-secret}}","type":"text"},{"key":"Content-Type","value":"application/json"}],"url":"https://premium.pverify.com/Report/EligibilityPDFReport/","urlObject":{"protocol":"https","path":["Report","EligibilityPDFReport",""],"host":["premium","pverify","com"],"query":[],"variable":[]}},"response":[],"_postman_id":"ec730ff0-34aa-4056-a99c-4f791fd6008b"},{"name":"Details URL","id":"c9008120-4d00-4539-af47-525d789b1b1a","protocolProfileBehavior":{"disableBodyPruning":true},"request":{"method":"GET","header":[{"key":"Authorization","value":"Bearer {{access-token}}","type":"text"},{"key":"Client-API-Id","value":"{{client-api-id}}","type":"text"},{"key":"Content-Type","value":"application/json","type":"text"}],"url":"https://api.pverify.com/API/GetEligibilityDetailsURL/{requestID}","description":"

\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n

Environment	URL
Test	/API/GetEligibilityDetailsURL/{id}
Production	/API/GetEligibilityDetailsURL/{id}

This GET method will return details URL with Eligibility Request ID as a parameter.

GetEligibilityDetailsURL Request

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Key	Value
URL	/API/GetEligibilityDetailsURL/{id}
Method	GET
Headers	Description
Authorization	Authorization token from above preceded by the String \"Bearer\"
Client-API-Id*	Your pVerify client-api-id
Content-Type	application/json

*Note: The Client-API-Id header is required. Header keys are case sensitive.

GetEligibilityDetailsURL Resposne

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Key	Value
isDetailsURLGenerated	True or false
url	string URL
errorMessage	Message when isDetailsURLGenerated is false

JSON Response

{

\"isDetailsURLGenerated\": true,

\"url\": \"https://premium.pverify.com/Details\",

\"errorMessage\": null

}

\n","urlObject":{"protocol":"https","path":["API","GetEligibilityDetailsURL","{requestID}"],"host":["api","pverify","com"],"query":[],"variable":[]}},"response":[],"_postman_id":"c9008120-4d00-4539-af47-525d789b1b1a"}],"id":"f616b939-f39a-41dc-92c8-cdcc96da2d06","_postman_id":"f616b939-f39a-41dc-92c8-cdcc96da2d06","description":""},{"name":"Dental Eligibility","item":[{"name":"DentalEligibilitySummary","id":"f9194243-51e7-457f-9c0e-756ef5ee45f6","protocolProfileBehavior":{"disableBodyPruning":true},"request":{"method":"POST","header":[{"key":"Authorization","value":"Bearer {{access-token}}","type":"text"},{"key":"Client-API-Id","value":"{{client-api-id}}","type":"text"},{"key":"Content-Type","value":"application/json","type":"text"}],"body":{"mode":"raw","raw":"{\r\n\t\"payerCode\": \"DE0171\",\r\n\t\"payerName\": \"Delta Dental of Washington\",\r\n\r\n\t\"provider\": {\r\n\t\t\"firstName\": \"\",\r\n\t\t\"middleName\": \"\",\r\n\t\t\"lastName\": \" test name\",\r\n\t\t\"npi\": \"1427006147\",\r\n \"TaxId\":\"123456789\"\r\n\t},\r\n\t\"subscriber\": {\r\n\t\t\"firstName\": \"\",\r\n\t\t\"dob\": \"01/01/1950\",\r\n\t\t\"lastName\": \"\",\r\n\t\t\"memberID\": \"1234567890\"\r\n\t},\r\n\t\"dependent\": null,\r\n\r\n\t\"isSubscriberPatient\": \"True\",\r\n\t\"doS_StartDate\": \"02/02/2021\",\r\n\t\"doS_EndDate\": \"02/02/2021\",\r\n\r\n\t\"PracticeTypeCode\": \"86\",\r\n\t\"referenceId\": \"Pat MRN\",\r\n\t\"Location\": \"Any location Name\",\r\n\t\"IncludeHtmlResponse\": false,\r\n \"dCodes\": [\r\n \"D0120\",\r\n \"D0145\"\r\n ]\r\n\r\n}"},"url":"https://api.pverify.com/api/DentalEligibilitySummary","description":"

There two type of verifications Self and Dependent.

DentalEligibilitySummary Request Details

Property Name	Data Type	Usage	Description
PayerCode	String	Required	pVerify payer Code or Client payer map code (i.e. Delta Dental of WH-DE0171)
PayerName	String	Optional	Payer Name
Provider.FirstName	String	Optional	Provider first name
Provider.LastName	String	Required	Provider last name
Provider.NPI	String	Required	10-digit NPI value
Provider.TaxId	String	Required	Tax Id
Subscriber.FirstName	String	Conditional	First Name of subscriber required for self-inquiry
Subscriber.LastName	String	Conditional	Last Name of subscriber required for self-inquiry
Subscriber.MemberId	String	Required	Member Id required for both type inquiries (self, dependent)
Subscriber.DOB	String	Conditional	Required for self-inquiry for better matching result Format is MM/dd/yyyy
Subscriber.SSN	String	Optional	SSN of subscriber
isSubscriberPatient	String	Required	True for self and False for Dependent inquiry
doS_StartDate	String	Required	Date of service start date in MM/dd/yyyy format
doS_EndDate	String	Required	Date of service end date in MM/dd/yyyy format
PracticeTypeCode	Number	Optional	Default practice type is 86
Location	String	Optional	Default is clients default location.
ReferenceId	String	Optional	Any refence Id,for ex: Patient MRN
IncludeHTMLResponse	Boolean	Optional	Default is false, if true then Entire response will be returned as formatted text in Response Test along with Summary details.
Dependent	Object	Conditional	Required for dependent inquiry
Dependent.Patient.FirstName	String	Conditional	First Name of dependent required for dependent inquiry
Dependent.Patient.LastName	String	Conditional	Last Name of dependent required for dependent inquiry
Dependent.Patient.DOB	String	Conditional	Required for dependent inquiry for better matching result Format is MM/dd/yyyy
DCodes	Object	Conditional	Dental Diagnosis Codes to get coinsurance and Deductible values

DentalEligibilitySummary Response details

\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n

Key	Type	Description
RequestID	Integer	Eligibility Transaction ID
APIResponseCode	String	0-Processed,1-Rejected,3-Pending
APIResponseMessage	String	Message about the transaction
VerificationType	String	Verification Type –Subscriber or dependent
DOS	String	Date of service start date – DOS end date
Is HMO Plan	Boolean	If true then Patient has HMO plan
ExceptionNotes	String	\"Exception Notes if any . If response demographic info is not matched with that of Request\"
AdditionalInformation	String	If there is any other info
DemographicInfo	Object	It contains the subscriber info or dependent info .
ServiceDetails	Object	\"It contains all Service type details info\"
PreventiveServices	Object	Contains Preventive codes details
OtherPayerInfo	Object	It contains Other Payer info. It is null then there is no payer change.
PlanCoverageSummary	object	It contains Plan related info.
DentalInfo	Object	It contains response as formatted HTML response when IncludeHTMLResponse of request is true.
ResponseText	String
DCodes	Object	It contains the dental diagnosis codes used for deductible and coinsurance values

","urlObject":{"protocol":"https","path":["api","DentalEligibilitySummary"],"host":["api","pverify","com"],"query":[],"variable":[]}},"response":[],"_postman_id":"f9194243-51e7-457f-9c0e-756ef5ee45f6"},{"name":"DentalEligibilityBenefitSummary","id":"4ade407d-f787-46bf-bfd9-6abbcb3fcf51","protocolProfileBehavior":{"disableBodyPruning":true},"request":{"method":"POST","header":[{"key":"Authorization","type":"text","value":"Bearer {{access-token}}"},{"key":"Client-API-Id","type":"text","value":"{{client-api-id}}"},{"key":"Content-Type","type":"text","value":"application/json"}],"body":{"mode":"raw","raw":"{\r\n\t\"payerCode\": \"DE0171\",\r\n\t\"payerName\": \"Delta Dental of Washington\",\r\n\r\n\t\"provider\": {\r\n\t\t\"firstName\": \"\",\r\n\t\t\"middleName\": \"\",\r\n\t\t\"lastName\": \" test name\",\r\n\t\t\"npi\": \"1427006147\",\r\n \"TaxId\":\"123456789\"\r\n\t},\r\n\t\"subscriber\": {\r\n\t\t\"firstName\": \"\",\r\n\t\t\"dob\": \"01/01/1950\",\r\n\t\t\"lastName\": \"\",\r\n\t\t\"memberID\": \"1234567890\"\r\n\t},\r\n\t\"dependent\": null,\r\n\r\n\t\"isSubscriberPatient\": \"True\",\r\n\t\"doS_StartDate\": \"02/02/2021\",\r\n\t\"doS_EndDate\": \"02/02/2021\",\r\n\r\n\t\"PracticeTypeCode\": \"86\",\r\n\t\"referenceId\": \"Pat MRN\",\r\n\t\"Location\": \"Any location Name\",\r\n\t\"IncludeHtmlResponse\": false\r\n\r\n}"},"url":"https://api.pverify.com/api/DentalEligibilityBenefitSummary","description":"

There two type of verifications Self and Dependent.

DentalEligibilityBenefitSummary Request Details

Property Name	Data Type	Usage	Description
PayerCode	String	Required	pVerify payer Code or Client payer map code (i.e. Delta Dental of WH-DE0171)
PayerName	String	Optional	Payer Name
Provider.FirstName	String	Optional	Provider first name
Provider.LastName	String	Required	Provider last name
Provider.NPI	String	Required	10-digit NPI value
Provider.TaxId	String	Required	Tax Id
Subscriber.FirstName	String	Conditional	First Name of subscriber required for self-inquiry
Subscriber.LastName	String	Conditional	Last Name of subscriber required for self-inquiry
Subscriber.MemberId	String	Required	Member Id required for both type inquiries (self, dependent)
Subscriber.DOB	String	Conditional	Required for self-inquiry for better matching result Format is MM/dd/yyyy
Subscriber.SSN	String	Optional	SSN of subscriber
isSubscriberPatient	String	Required	True for self and False for Dependent inquiry
doS_StartDate	String	Required	Date of service start date in MM/dd/yyyy format
doS_EndDate	String	Required	Date of service end date in MM/dd/yyyy format
PracticeTypeCode	Number	Optional	Default practice type is 86
Location	String	Optional	Default is clients default location.
ReferenceId	String	Optional	Any refence Id,for ex: Patient MRN
IncludeHTMLResponse	Boolean	Optional	Default is false, if true then Entire response will be returned as formatted text in Response Test along with Summary details.
Dependent	Object	Conditional	Required for dependent inquiry
Dependent.Patient.FirstName	String	Conditional	First Name of dependent required for dependent inquiry
Dependent.Patient.LastName	String	Conditional	Last Name of dependent required for dependent inquiry
Dependent.Patient.DOB	String	Conditional	Required for dependent inquiry for better matching result Format is MM/dd/yyyy

DentalEligibilityBenefitSummary Response details

\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n

Key	Type	Description
RequestID	Integer	Eligibility Transaction ID
APIResponseCode	String	0-Processed,1-Rejected,3-Pending
APIResponseMessage	String	Message about the transaction
VerificationType	String	Verification Type –Subscriber or dependent
DOS	String	Date of service start date – DOS end date
Is HMO Plan	Boolean	If true then Patient has HMO plan
ExceptionNotes	String	\"Exception Notes if any . If response demographic info is not matched with that of Request\"
AdditionalInformation	String	If there is any other info
DemographicInfo	Object	It contains the subscriber info or dependent info .
BenefitDetails	Object	It contains all details info group by Benefit type. Ex ; Dedcutible, Co-pay.
PreventiveServices	Object	Contains Preventive codes details
OtherPayerInfo	Object	It contains Other Payer info. It is null then there is no payer change.
PlanCoverageSummary	object	It contains Plan related info.
DentalInfo	Object	It contains response as formatted HTML response when IncludeHTMLResponse of request is true.
ResponseText	String

","urlObject":{"protocol":"https","path":["api","DentalEligibilityBenefitSummary"],"host":["api","pverify","com"],"query":[],"variable":[]}},"response":[],"_postman_id":"4ade407d-f787-46bf-bfd9-6abbcb3fcf51"},{"name":"GetEligibilitySummary","id":"2c2c56ac-d11e-4f81-9d7f-9a651107844a","protocolProfileBehavior":{"disableBodyPruning":true},"request":{"method":"GET","header":[{"key":"Authorization","type":"text","value":"Bearer {{access-token}}"},{"key":"Client-API-Id","type":"text","value":"{{client-api-id}}"},{"key":"Content-Type","type":"text","value":"application/json"}],"url":"https://api.pverify.com/API/GetEligibilitySummary/9882795","description":"

\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n

Environment	URL
Test	https://testapi.pverify.com/API/GetEligibilitySummary
Production	https://api.pverify.com/API/GetEligibilitySummary

Headers

\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n

Key	Value
URL	https://api.pverify.com/API/GetEligibilitySummary
Method	GET
Headers	Description
Authorization	Authorization token from above preceded by the String \"Bearer\"
Client-API-Id*	Your pVerify client-api-id
Client-API-Id	API ID provided by pVerify
Content-Type	application/json
URL Parameters	RequestId returned in EligibilitySummary response

*Note: The Client-API-Id header is required. Header keys are case sensitive.

GetEligibilitySummary Response Fields

\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n

Key	Type	Description
RequestID	Integer	Eligibility Transaction ID
APIResponseCode	Integer	0-Processed,1-Rejected
APIResponseMessage	String	Message about the transaction
VerificationType	String	Verification Type –Subscriber or dependent
VerificationStatus	String	Eligibility Transaction Status- Values : Processed, Pending, Rejected
DOS	String	Date of service start date – DOS end date
Is HMO Plan	Boolean	If true then Patient has HMO plan
ExceptionNotes	String	Exception Notes if any. If response demographic info is not matched with that of Request
AddtionalInformation	String	If there is any other info
DemographicInfo	Object	It contains the subscriber info or dependent info
ServiceDetails	Object	It contains all Service type details info
OtherPayerInfo	Object	It contains Other Payer info. It is null then there is no payer change.
PlanCoverageSummary	object	It contains Plan realted info.
DentalInfo	Object	It contains response as formatted HTML response when IncludeHTMLResponse of request is true.

","urlObject":{"protocol":"https","path":["API","GetEligibilitySummary","9882795"],"host":["api","pverify","com"],"query":[],"variable":[]}},"response":[],"_postman_id":"2c2c56ac-d11e-4f81-9d7f-9a651107844a"},{"name":"V2 DentalEligibilitySummary","id":"4faf4e49-dc74-4cb0-bef2-3ddd16e2b7a5","protocolProfileBehavior":{"disableBodyPruning":true},"request":{"method":"POST","header":[{"key":"Authorization","value":"Bearer {{access-token}}","type":"text"},{"key":"Client-API-Id","value":"{{client-api-id}}","type":"text"},{"key":"Content-Type","value":"application/json","type":"text"}],"body":{"mode":"raw","raw":"{\r\n\t\"payerCode\": \"DE0171\",\r\n\t\"payerName\": \"Delta Dental of Washington\",\r\n\r\n\t\"provider\": {\r\n\t\t\"firstName\": \"\",\r\n\t\t\"middleName\": \"\",\r\n\t\t\"lastName\": \" test name\",\r\n\t\t\"npi\": \"1234567890\",\r\n \"TaxId\":\"123456789\"\r\n\t},\r\n\t\"subscriber\": {\r\n\t\t\"firstName\": \"fname\",\r\n\t\t\"dob\": \"01/01/1950\",\r\n\t\t\"lastName\": \"lname\",\r\n\t\t\"memberID\": \"1234567890\"\r\n\t},\r\n\t\"dependent\": null,\r\n\r\n\t\"isSubscriberPatient\": \"True\",\r\n\t\"doS_StartDate\": \"02/02/2021\",\r\n\t\"doS_EndDate\": \"02/02/2021\",\r\n\r\n\t\"PracticeTypeCode\": \"86\",\r\n\t\"referenceId\": \"Pat MRN\",\r\n\t\"Location\": \"Any location Name\",\r\n\t\"IncludeHtmlResponse\": false,\r\n \"dCodes\": [\r\n \"D0120\",\r\n \"D0145\"\r\n ]\r\n\r\n}"},"url":"https://api.pverify.com/api/v2/DentalEligibilitySummary","description":"

There two type of verifications Self and Dependent.

V2 DentalEligibilitySummary Request Details

Property Name	Data Type	Usage	Description
PayerCode	String	Required	pVerify payer Code or Client payer map code (i.e. Delta Dental of WH-DE0171)
PayerName	String	Optional	Payer Name
Provider.FirstName	String	Optional	Provider first name
Provider.LastName	String	Required	Provider last name
Provider.NPI	String	Required	10-digit NPI value
Provider.TaxId	String	Required	Tax Id
Subscriber.FirstName	String	Conditional	First Name of subscriber required for self-inquiry
Subscriber.LastName	String	Conditional	Last Name of subscriber required for self-inquiry
Subscriber.MemberId	String	Required	Member Id required for both type inquiries (self, dependent)
Subscriber.DOB	String	Conditional	Required for self-inquiry for better matching result Format is MM/dd/yyyy
Subscriber.SSN	String	Optional	SSN of subscriber
isSubscriberPatient	String	Required	True for self and False for Dependent inquiry
doS_StartDate	String	Required	Date of service start date in MM/dd/yyyy format
doS_EndDate	String	Required	Date of service end date in MM/dd/yyyy format
PracticeTypeCode	Number	Optional	Default practice type is 86
Location	String	Optional	Default is clients default location.
ReferenceId	String	Optional	Any refence Id,for ex: Patient MRN
IncludeHTMLResponse	Boolean	Optional	Default is false, if true then Entire response will be returned as formatted text in Response Test along with Summary details.
Dependent	Object	Conditional	Required for dependent inquiry
Dependent.Patient.FirstName	String	Conditional	First Name of dependent required for dependent inquiry
Dependent.Patient.LastName	String	Conditional	Last Name of dependent required for dependent inquiry
Dependent.Patient.DOB	String	Conditional	Required for dependent inquiry for better matching result Format is MM/dd/yyyy
DCodes	Object	Conditional	Dental Diagnosis Codes to get coinsurance and Deductible values

DentalEligibilitySummary Response details

Key	Type	Description
RequestID	long	Eligibility Transaction ID
APIResponseCode	String	0-Processed,1-Rejected,3-Pending
APIResponseMessage	String	Message about the transaction
EDIErrorMessage	String	EDI error messages if any
FollowUpAction	String	Actions to be taken based on payer response
PossibleResolution	String	Possible solutions if any
ProcessedWithError	Boolean	If transaction verified with error, the value will be false
ErrorCode	String	Transaction Error Code
ErrorDescription	String	Transaction Error Description
PverifyPayerCode	String	Pverify Payer Code
PayerName	String	Pverify Payer Name
ClientPayerName	String	Client Payer Name if any
VerificationType	String	Verification Type –Subscriber or dependent
DOS	String	Date of service start date – DOS end date
Is HMO Plan	Boolean	If true then Patient has HMO plan
ExceptionNotes	String	\"Exception Notes if any . If response demographic info is not matched with that of Request\"
AdditionalInformation	String	If there is any other info
Location	String	Client Location
ReferenceId	String	Reference Id of Practice
InternalId	String	Internal Id of Practice
CustomerId	String	Customer Id in request
Notes	String	Notes if there are any in the response
ResultPracticeType	String	Practice Type which is processed by payer
AreAllSTCsProcessed	Boolean	Processed by
STCsStatusMessage	String	Service Codes status messages if any
IsProviderInNetwork	Boolean	If provider is in with in network, it will return true
IsSkipped	Boolean	if transaction get skipped(same transaction if we verify multiple time, transaction will be skipped and return last successful verified response), it will be true
DetailsURL	String	Details URL for view transaction results
IsPriorAuthRequired	String	If any service require pre approval
DemographicInfo	Object	It contains the subscriber info or dependent info .
ServiceDetails	Object	\"It contains all Service type details info\"
OtherPayerInfo	Object	It contains Other Payer info. It is null then there is no payer change.
PlanCoverageSummary	object	It contains Plan related info.
HBPC_Deductible_OOP_Summary	object	It contains HBPC related info.
MiscellaneousInfoSummary	object	MiscellaneousInfoSummary
DentalSummary	PracticeTypeSummary	It contains Dental Care Summary specific info
DentalAdjunctiveServiceSummary	PracticeTypeSummary	It contains Dental Adjunctive Service Summary specific info
DentalAnesthesiaSummary	PracticeTypeSummary	It contains Dental Anesthesia Summary specific info
DentalCrownSummary	PracticeTypeSummary	It contains the Dental Crown Summary specific values
DentalDiagnosticSummary	PracticeTypeSummary	It contains Dental Diagnostic Summary specific values
DentalDiagnosticXRaySummary	PracticeTypeSummary	It contains Dental Diagnostic X-Ray Summary specific values
DentalEndodonticSummary	PracticeTypeSummary	It contains Dental Endodontics Summary specific values
DentalMaxillofacialProstheticSummary	PracticeTypeSummary	It contains Dental Maxillofacial Prosthetic Summary specific values
DentalOrthodonticSummary	PracticeTypeSummary	It contains Dental Orthodontics Summary specific values
DentalPeriodonticSummary	PracticeTypeSummary	It contains Dental Periodontics Summary specific values
DentalProsthodonticSummary	PracticeTypeSummary	It contains Dental Prosthodontics Summary specific values
DentalRestorativeSummary	PracticeTypeSummary	It contains Dental Restorative Summary specific values
DentalRoutineSummary	PracticeTypeSummary	It contains Dental Routine Summary specific values

","urlObject":{"protocol":"https","path":["api","v2","DentalEligibilitySummary"],"host":["api","pverify","com"],"query":[],"variable":[]}},"response":[],"_postman_id":"4faf4e49-dc74-4cb0-bef2-3ddd16e2b7a5"},{"name":"GetDentalEligibilitySummary","id":"9a770f85-a7af-4bfb-9683-22219a480049","protocolProfileBehavior":{"disableBodyPruning":true},"request":{"method":"GET","header":[{"key":"Authorization","value":"Bearer {{access-token}}","type":"text"},{"key":"Client-API-Id","value":"{{client-api-id}}","type":"text"},{"key":"Content-Type","value":"application/json","type":"text"}],"url":"https://api.pverify.com/API/GetDentalEligibilitySummary/9882795","description":"

\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n

Environment	URL
Test	https://testapi.pverify.com/API/GetDentalEligibilitySummary
Production	https://api.pverify.com/API/GetDentalEligibilitySummary

Headers

\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n

Key	Value
URL	https://api.pverify.com/Test/API/GetDentalEligibilitySummary
Method	GET
Headers	Description
Authorization	Authorization token from above preceded by the String \"Bearer\"
Client-API-Id*	Your pVerify client-api-id
Client-API-Id	API ID provided by pVerify
Content-Type	application/json
URL Parameters	RequestId returned in Dental EligibilitySummary response

*Note: The Client-API-Id header is required. Header keys are case sensitive.

GetDentalEligibilitySummary Response Fields

Key	Type	Description
RequestID	long	Eligibility Transaction ID
APIResponseCode	String	0-Processed,1-Rejected,3-Pending
APIResponseMessage	String	Message about the transaction
EDIErrorMessage	String	EDI error messages if any
FollowUpAction	String	Actions to be taken based on payer response
PossibleResolution	String	Possible solutions if any
ProcessedWithError	Boolean	If transaction verified with error, the value will be false
ErrorCode	String	Transaction Error Code
ErrorDescription	String	Transaction Error Description
PverifyPayerCode	String	Pverify Payer Code
PayerName	String	Pverify Payer Name
ClientPayerName	String	Client Payer Name if any
VerificationType	String	Verification Type –Subscriber or dependent
DOS	String	Date of service start date – DOS end date
Is HMO Plan	Boolean	If true then Patient has HMO plan
ExceptionNotes	String	\"Exception Notes if any . If response demographic info is not matched with that of Request\"
AdditionalInformation	String	If there is any other info
Location	String	Client Location
ReferenceId	String	Reference Id of Practice
InternalId	String	Internal Id of Practice
CustomerId	String	Customer Id in request
Notes	String	Notes if there are any in the response
ResultPracticeType	String	Practice Type which is processed by payer
AreAllSTCsProcessed	Boolean	Processed by
STCsStatusMessage	String	Service Codes status messages if any
IsProviderInNetwork	Boolean	If provider is in with in network, it will return true
IsSkipped	Boolean	if transaction get skipped(same transaction if we verify multiple time, transaction will be skipped and return last successful verified response), it will be true
DetailsURL	String	Details URL for view transaction results
IsPriorAuthRequired	String	If any service require pre approval
DemographicInfo	Object	It contains the subscriber info or dependent info .
ServiceDetails	Object	\"It contains all Service type details info\"
OtherPayerInfo	Object	It contains Other Payer info. It is null then there is no payer change.
PlanCoverageSummary	object	It contains Plan related info.
HBPC_Deductible_OOP_Summary	object	It contains HBPC related info.
MiscellaneousInfoSummary	object	MiscellaneousInfoSummary
DentalSummary	PracticeTypeSummary	It contains Dental Care Summary specific info
DentalAdjunctiveServiceSummary	PracticeTypeSummary	It contains Dental Adjunctive Service Summary specific info
DentalAnesthesiaSummary	PracticeTypeSummary	It contains Dental Anesthesia Summary specific info
DentalCrownSummary	PracticeTypeSummary	It contains the Dental Crown Summary specific values
DentalDiagnosticSummary	PracticeTypeSummary	It contains Dental Diagnostic Summary specific values
DentalDiagnosticXRaySummary	PracticeTypeSummary	It contains Dental Diagnostic X-Ray Summary specific values
DentalEndodonticSummary	PracticeTypeSummary	It contains Dental Endodontics Summary specific values
DentalMaxillofacialProstheticSummary	PracticeTypeSummary	It contains Dental Maxillofacial Prosthetic Summary specific values
DentalOrthodonticSummary	PracticeTypeSummary	It contains Dental Orthodontics Summary specific values
DentalPeriodonticSummary	PracticeTypeSummary	It contains Dental Periodontics Summary specific values
DentalProsthodonticSummary	PracticeTypeSummary	It contains Dental Prosthodontics Summary specific values
DentalRestorativeSummary	PracticeTypeSummary	It contains Dental Restorative Summary specific values
DentalRoutineSummary	PracticeTypeSummary	It contains Dental Routine Summary specific values

","urlObject":{"protocol":"https","path":["API","GetDentalEligibilitySummary","9882795"],"host":["api","pverify","com"],"query":[],"variable":[]}},"response":[],"_postman_id":"9a770f85-a7af-4bfb-9683-22219a480049"}],"id":"c2be994e-a80b-432a-a3ad-867a502d5e76","_postman_id":"c2be994e-a80b-432a-a3ad-867a502d5e76","description":""},{"name":"Same or Similar","item":[{"name":"SameOrSimilarInquiry","id":"166db4e2-0a5f-4a5d-842e-0566ccf6de77","protocolProfileBehavior":{"disableBodyPruning":true},"request":{"method":"POST","header":[{"key":"Authorization","type":"text","value":"Bearer {{access-token}}"},{"key":"Client-API-Id","type":"text","value":"{{client-api-id}}"},{"key":"Content-Type","type":"text","value":"application/json"}],"body":{"mode":"raw","raw":"{\r\n \"memberId\": \"1231234567\",\r\n \"patientFirstName\": \"Test1\",\r\n \"patientLastName\": \"Test2\",\r\n \"patientDOB\": \"01/02/2020\",\r\n \"patientStateCode\": \"NJ\",\r\n \"hcpcsCodes\": \"L3960,L3982,L3995\",\r\n \"dosStart\": \"04/21/2020\",\r\n \"dosEnd\": \"04/21/2020\",\r\n \"location\": \"location Name\",\r\n \"callBackUrl\": \"\"\r\n}"},"url":"https://api.pverify.com/API/SameOrSimilarInquiry","description":"

\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n

Environment	URL
Test	https://testapi.pverify.com/API/SameOrSimilarInquiry
Production	https://api.pverify.com/API/SameOrSimilarInquiry

This endpoint submits a Same/Similar request into our queue. Note that this is not real time, and either the postback URL must be used (to submit the response to), or the GetSameOrSimilarResponse endpoint must be called with the request ID.

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Key	Value
URL	https://api.pverify.com/API/SameOrSimilarInquiry
Method	POST
Headers	Description
Content-Type	application/json
Authorization	Authorization token from above preceded by the String \"Bearer\"
Client-API-Id*	Your pVerify client-api-id
Body	Description
Data Parameters	See Right Panel

*Note: The Client-API-Id is required in header. Header keys are case sensitive.

SameOrSimilarInquiry Request fields

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Property Name	Data Type	Usage	Description
memberId	String	Required	Patient's member ID (MBI).
patient.FirstName	String	Required	Patient First Name.
patientLastName	String	Required	Patient Last Name.
patientDOB	String	Required	Patient DOB (Expected format: MM/dd/YYYY ie 01/01/2000).
patientStateCode	String	Required	Patient State Code ex: AL.
hcpcsCodes	String	Required	HCPCS starting with A, B, E, K and L Codes supported, can sent multiple codes in same alphabetical category separated by comma.
dosStart	String	Optional	Date of service start date (Expected format: MM/dd/YYYY ie 01/01/2000). Default value is 5 years before date to current date.
dosEnd	String	Optional	Date of service end date (Expected format: MM/dd/YYYY ie 01/01/2000). Default value is current date (Today's date).
location	String	Optional	Location name and the default is client user's location or client's location.
callbackURL	String	Optional	JSON response will be posted to callbackURL when inquiry is processed and if callbackURL is valid. This URL should support HTTP POST method and Content-Type =’application/json’

APIResponseCode Meaning

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APIResponseCode	Description
0	Processed
1	Rejected
2	NoFunds (Insufficient Account Balance)
3	Pending (Pending need to get response later)
4	InvalidRequest (Required Data Missing)
5	InvalidFormat (data fields / data format is wrong)
6	LocationError (Location is not configured)

Same or Similar Response Details

Property Name	Data Type	Description
RequestId	long	Same or Similar Request ID.
apiResponseCode	int	API transaction response code. Please see apiResponseCodes section.
apiResponseMessage	String	API transaction response message.
isDataError	boolean	True - when invalid patient details (Invalid MBI or Incorrect DOB, Name etc)
Claims	List
	Contains claim status info.
Message	String	Contains messages other than error messages (No claims found).
Status	String	Status of transaction.
Claim.HCPCS	String	Contains HCPCS returned in response.
Claim.Status	String	Contains Claim & Code status âAllowed ,Denied or No Claims. For Invalid data request it is Error.
Claim.DOSStart	String	Claim & Code Date of service start date. It is empty for Error or for No Claims. (Expected format: MM/dd/YYYY ie 01/01/2000)
Claim.DOSEnd	String	Claim & Code Date of service end date. It is empty for Jurisdiction A and D inquiries. It is empty for Error or for No Claims. (Expected format: MM/dd/YYYY ie 01/01/2000)
Claim.Unit	String	No of units.
Claim.SupplierName	String	Contains supplier name for all allowed or denied requests. Empty for no claims & error.
Claim.phone	String	Contains supplier phone number for all allowed or denied. Empty for no claims & error.
Claim.Message	String	Contains notes or error message, Ex: No claims found or Invalid MBI or Incorrect DOB or Incorrect name
DetailsURL	string	URL for the full report
ExpectedTimeInSeconds	string	It gives expected response time in seconds

Response JSON Processing Steps

Step 1: Check the value of the API Response Code property. If the API Response Code is 3 (Pending) then the request is pending and the Request ID can be extracted.

Step 2: Save the data

Note: The Same or Similar API always returns API response code as 3 (pending)

\n","urlObject":{"protocol":"https","path":["API","SameOrSimilarInquiry"],"host":["api","pverify","com"],"query":[],"variable":[]}},"response":[],"_postman_id":"166db4e2-0a5f-4a5d-842e-0566ccf6de77"},{"name":"GetSameOrSimilarResponse","id":"45811fd0-051e-4658-a8d9-ce17e5cc5702","protocolProfileBehavior":{"disableBodyPruning":true},"request":{"method":"GET","header":[{"key":"Authorization","type":"text","value":"Bearer {{access-token}}"},{"key":"Client-API-Id","type":"text","value":"{{client-api-id}}"},{"key":"Content-Type","type":"text","value":"application/json"}],"url":"https://api.pverify.com/API/GetSameOrSimilarResponse/1033246","description":"

Get Same or Similar Response Using Unique Request ID

\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n

Environment	URL
Test	https://testapi.pverify.com/API/GetSameOrSimilarResponse/125
Production	https://api.pverify.com/API/GetSameOrSimilarResponse/125

This call is used to get the transaction result later using a unique request ID.

Note: We purge this data after 90 days

\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n

Key	Value
URL	https://api.pverify.com/API/GetSameOrSimilarResponse/125
Method	GET
Headers	Description
Content-Type	application/json
Authorization	Authorization token from above preceded by the String \"Bearer\"
Client-API-Id*	Your pVerify client-api-id

*Note: The Client-API-Id header is required. Header keys are case sensitive.

Notes

Always check for apiResponseCode property value before processing.
\n
If APIResponseCode is zero then look for ErrorMessage and Claims to process response.
\n

A successful GetSameOrSimilarResponse will have the same format as the SameOrSimilarInquiry response.

API Response Codes

\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n

APIResponseCode	Description
0	Processed
1	Rejected
2	NoFunds (Insufficient Account Balance)
3	Pending (Pending need to get response later)
4	InvalidRequest (Required Data Missing)
5	InvalidFormat (data fields / data format is wrong)
6	LocationError (Location is not configured)

Field Descriptions

Same or Similar Response Details

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Property Name	Data Type	Description
RequestId	long	Same or Similar Request ID.
apiResponseCode	int	API transaction response code. Please see apiResponseCodes section.
apiResponseMessage	String	API transaction response message.
isDataError	boolean	True - when invalid patient details (Invalid MBI or Incorrect DOB, Name etc)
Claims	List
	Contains claim status info.
Message	String	Contains messages other than error messages (No claims found).
Status	String	Status of transaction.
Claim.HCPCS	String	Contains HCPCS returned in response.
Claim.Status	String	Contains Claim & Code status âAllowed ,Denied or No Claims. For Invalid data request it is Error.
Claim.DOSStart	String	Claim & Code Date of service start date. It is empty for Error or for No Claims. (Expected format: MM/dd/YYYY ie 01/01/2000)
Claim.DOSEnd	String	Claim & Code Date of service end date. It is empty for Jurisdiction A and D inquiries. It is empty for Error or for No Claims. (Expected format: MM/dd/YYYY ie 01/01/2000)
Claim.Unit	String	No of units.
Claim.SupplierName	String	Contains supplier name for all allowed or denied requests. Empty for no claims & error.
Claim.phone	String	Contains supplier phone number for all allowed or denied. Empty for no claims & error.
Claim.Message	String	Contains notes or error message, Ex: No claims found or Invalid MBI or Incorrect DOB or Incorrect name
DetailsURL	string	URL for the full report

","urlObject":{"protocol":"https","path":["API","GetSameOrSimilarResponse","1033246"],"host":["api","pverify","com"],"query":[],"variable":[]}},"response":[],"_postman_id":"45811fd0-051e-4658-a8d9-ce17e5cc5702"},{"name":"Same Or Similar Report","id":"dedbb65f-d8f2-44b2-af45-cb50d9189b52","protocolProfileBehavior":{"disableBodyPruning":true},"request":{"method":"GET","header":[{"key":"Content-Type","value":"application/json"},{"key":"Client-API-Id","value":"xxx"},{"key":"Client-Secret","value":"xxx"}],"url":"https://premium.pverify.com/PDFReport/SameorSimilar/{id}","description":"

This returns a PDF report of the Same or Similar request.

Note two things:

The endpoint is premium.pverify.com
Authentication token is not used, instead pass your API ID and Secret.

\n","urlObject":{"protocol":"https","path":["PDFReport","SameorSimilar","{id}"],"host":["premium","pverify","com"],"query":[],"variable":[]}},"response":[],"_postman_id":"dedbb65f-d8f2-44b2-af45-cb50d9189b52"},{"name":"SoS Details URL","id":"71e79aa5-2411-4663-b80a-ab35753c41eb","protocolProfileBehavior":{"disableBodyPruning":true},"request":{"method":"GET","header":[{"key":"Authorization","value":"Bearer {{access-token}}","type":"text"},{"key":"Client-API-Id","value":"{{client-api-id}}","type":"text"},{"key":"Content-Type","value":"application/json","type":"text"}],"url":"https://api.pverify.com/API/GetSameAndSimilarDetailsURL/{requestID}","description":"

\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n

Environment	URL
Test	/API/GetSameAndSimilarDetailsURL/{id}
Production	/API/GetSameAndSimilarDetailsURL/{id}

This GET method will return details URL with Same and Simialr Request ID as a parameter.

GetSameAndSimilarDetailsURL Request

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Key	Value
URL	/API/GetSameAndSimilarDetailsURL/{id}
Method	GET
Headers	Description
Authorization	Authorization token from above preceded by the String \"Bearer\"
Client-API-Id*	Your pVerify client-api-id
Content-Type	application/json

*Note: The Client-API-Id header is required. Header keys are case sensitive.

GetSameAndSimilarDetailsURL Resposne

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Key	Value
isDetailsURLGenerated	True or false
url	string URL
errorMessage	Message when isDetailsURLGenerated is false

JSON Response

{

\"isDetailsURLGenerated\": true,

\"url\": \"https://premium.pverify.com/Details\",

\"errorMessage\": null

}

\n","urlObject":{"protocol":"https","path":["API","GetSameAndSimilarDetailsURL","{requestID}"],"host":["api","pverify","com"],"query":[],"variable":[]}},"response":[],"_postman_id":"71e79aa5-2411-4663-b80a-ab35753c41eb"}],"id":"27c1350f-031f-4b1a-986e-35f0ba49882e","description":"

pVerify has two RESTful API end points to give Same or Similar HCPCS(L code) Status information,

This workflow is:

Get Token via Token call,
\n
Call SameOrSimilarInquiry and pass the token along with demographic information.
\n
Call GetSameOrSimilarResponse/{requestId} later to get the results and pass the token.
\n

Note : Same Token can be used in subsequent inquiries.

The JSON Viewer URL

Credentials\nTo use these calls, you will need to set up an account and be given a username & password or client-api-id & client-secret. Please contact the pVerify team for this information.

\n","event":[{"listen":"prerequest","script":{"id":"113be2f2-006b-44fa-9fdc-ab5be9ffa275","type":"text/javascript","exec":[""]}},{"listen":"test","script":{"id":"b5845783-abc2-4194-b30c-eafb43eecb1a","type":"text/javascript","exec":[""]}}],"_postman_id":"27c1350f-031f-4b1a-986e-35f0ba49882e"},{"name":"Skilled Nursing Facility","item":[{"name":"SNF Inquiry","id":"46dceae3-1110-459e-8aae-3c5235da393a","protocolProfileBehavior":{"disableBodyPruning":true},"request":{"method":"POST","header":[{"key":"Authorization","type":"text","value":"Bearer {{access-token}}"},{"key":"Client-API-Id","type":"text","value":"{{client-api-id}}"},{"key":"Content-Type","type":"text","value":"application/json"}],"body":{"mode":"raw","raw":"{\r\n \"PayerCode\":\"00007\",\r\n \"MemberId\":\"123456789A\",\r\n \"PatientFirstName\":\"firstName\",\r\n \"PatientLastName\":\"lastName\",\r\n \"PatientDOB\":\"01/02/1983\",\r\n \"PatientStateCode\":\"TX\",\r\n \"DOS\":\"07/22/2020\",\r\n \"Location\":null,\r\n \"CallbackURL\":null,\r\n \"MRN\":null\r\n}"},"url":"https://api.pverify.com/API/SNFInquiry","description":"

\n\n\n\n\n\n\n\n\n\n\n\n\n

Environment	URL
Production	https://api.pverify.com/API/SNFInquiry

The pVerify API for SNF is like Same or Similar in that it will not deliver a result instantly, instead the user is expected to call the GET method 1 minute later.

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Key	Value
URL	https://api.pverify.com/API/SNFInquiry
Method	POST
Headers	Description
Content-Type	application/json
Authorization	Authorization token from above preceded by the String \"Bearer\"
Client-API-Id*	Your pVerify client-api-id
Body	See Below

SNF Codes Inquiry Request Fields

\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n

Key	Type	Usage	Value
PayerCode	String	Required	Payer Code
MemberId	String	Required	Member ID
PatientFirstName	String	Required	Patient First Name
PatientLastName	String	Required	Patient Last Name
PatientDOB	String	Required	Patient Date of Birth (MM/DD/YYYY)
PatientStateCode	String	Required	Patient State
DOS	String	Optional	Date of Service (MM/DD/YYYY)
Location	String	Optional	Location is the practice location. Note by setting this, you will lock the patient to one location, so that users that login in via our portal who are not authorized to see that location will not see the patient.
CallbackURL	String	Optional	JSON response will be posted to callbackURL when inquiry is processed and if callbackURL is valid. This URL should support HTTP POST method and Content-Type =’application/json’
MRN	String	Optional	Medical Record Number (like Same or Similar, when populated we will send the results back to this URL) - optional

SNF Codes Inquiry Response Fields

Key	Type	Description
requestId	String	requestId
Processed	boolean	Returns true if processed
isDataError	boolean	Determines if data error occurred
errorMessage	String	Error Message
Details	Object	Details
Details.DOSStart	String	Date of service start date (Format: MM/DD/YYYY)
Details.DOSEnd	String	Date of service end (Format: MM/DD/YYYY)
Details.AdmitanceDate	String	Admitance date
Details.DischargedDate	String	Discharged date
Details.BillingNPI	String	Billing NPI
Details.PatientStatus	String	Patient Status
Details.Message	String	Details Message
Details.SNFRequestId	Int	SNF request ID
Details.CreatedOn	String	Date and time created
Details.BillingType	String	Billing type
Message	String	Message
Status	String	Status
expectedTimeInSeconds	String	Expected time to get response (when you can call GET)
apiResponseCode	int	API Response Code
apiResponseMessage	String	API Response Message

","urlObject":{"protocol":"https","path":["API","SNFInquiry"],"host":["api","pverify","com"],"query":[],"variable":[]}},"response":[],"_postman_id":"46dceae3-1110-459e-8aae-3c5235da393a"},{"name":"GetSNFResponse","id":"adf4c1b4-b2e3-46ee-9641-b5ffc2b51ba2","protocolProfileBehavior":{"disableBodyPruning":true},"request":{"method":"GET","header":[{"key":"Authorization","value":"Bearer {{access-token}}","type":"text"},{"key":"Client-API-Id","value":"{{client-api-id}}","type":"text"},{"key":"Content-Type","value":"application/json","type":"text"}],"body":{"mode":"raw","raw":""},"url":"https://api.pverify.com/API/GetSNFResponse/91931","description":"

\n\n\n\n\n\n\n\n\n\n\n\n\n

Environment	URL
Production	https://api.pverify.com/API/GETSNFResponse

This GET call is intended to retrieve the SNF response initiated by the SNFInquiry POST call. By adding the requestId received in the POST call, users can retrieve the SNFInquiry Response.

\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n

Key	Value
URL	https://api.pverify.com/API/GETSNFResponse
Method	GET
Headers	Description
Content-Type	application/json
Authorization	Authorization token from above preceded by the String \"Bearer\"
Client-API-Id*	Your pVerify client-api-id
Body	None
URL Params	RequestId (see SNFInquiry)

GetSNFResponse Response Fields

Key	Type	Description
requestId	String	requestId
Processed	boolean	Determines if processed
IsDataError	boolean	Determines if error occurred
errorMessage	String	Error Message
Details	Object	Details
Details.Id	int	Id
Details.DOSStart	String	Date of Service Start (MM/DD/YYYY)
Details.DOSEnd	String	Date of Service End (MM/DD/YYYY)
Details.AdmitanceDate	String	Admittance Date (MM/DD/YYYY)
Details.DischargedDate	String	Discharged Date (MM/DD/YYYY)
Details.BillingAPI	String	Billing API
Details.PatientStatus	String	Patient Status
Details.Message	String	Message
Details.SNFRequestID	int	SNF request ID
Details.CreatedOn	String	Time Stamp of date and time created
Details.BillingType	String	Billing Type
message	String	Message
status	String	Status
apiResponseCode	int	API Response Code
apiResponseMessage	String	API Response Message

","urlObject":{"protocol":"https","path":["API","GetSNFResponse","91931"],"host":["api","pverify","com"],"query":[],"variable":[]}},"response":[],"_postman_id":"adf4c1b4-b2e3-46ee-9641-b5ffc2b51ba2"}],"id":"a9b0a1c0-2fd5-4f53-bd66-b546cc179705","_postman_id":"a9b0a1c0-2fd5-4f53-bd66-b546cc179705","description":""},{"name":"Claim Status","item":[{"name":"ClaimStatusInquiry","id":"06a58c55-84f9-4fd7-b426-5ed126209025","protocolProfileBehavior":{"disableBodyPruning":true},"request":{"method":"POST","header":[{"key":"Authorization","type":"text","value":"Bearer {{access-token}}"},{"key":"Client-API-Id","type":"text","value":"{{client-api-id}}"},{"key":"Content-Type","type":"text","value":"application/json"}],"body":{"mode":"raw","raw":"{\r\n \"payerCode\": \"00001\", \r\n \"ProviderLastName\": \"lastname\",\r\n \"ProviderNPI\": \"1234567890\", \r\n \"ProviderFederalTaxId\": \"\",\r\n \"payerClaimNumber\": \"\",\r\n \"chargeAmount\": 732.87,\r\n \"serviceStartDate\": \"04/01/2020\",\r\n \"serviceEndDate\": \"04/01/2020\",\r\n \"subscriber\": {\r\n \"FirstName\": \"\",\r\n \"lastName\": \"lastname\",\r\n \"dob\": \"07/07/2010\",\r\n \"memberID\": \"memberID\",\r\n \"gender\" : null // or \"M\" or \"F\"\r\n },\r\n \"isPatientDependent\": false\r\n}","options":{"raw":{"language":"json"}}},"url":"https://api.pverify.com/API/ClaimStatusInquiry","description":"

\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n

Environment	URL
Test	https://testapi.pverify.com/API/ClaimStatusInquiry
Production	https://api.pverify.com/API/ClaimStatusInquiry

The ClaimStatusInquiry is the second step of the workflow for obtaining Claim status Information through pVerify. As demonstrated below, the ClaimStatusInquiry call takes in subscriber or dependent demographic information, along with the authorization token, and returns the claim status among other information. To use this or any other method, you must first generate a token via the Token endpoint (see above Token method).

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Field	Description
URL	https://api.pverify.com/API/ClaimStatusInquiry
Method	POST
Headers	Description
Content-Type	application/json
Authorization	Bearer XXX
Client-API-Id*	client-api-id provided by pVerify
Body	See right

*Note: The Client-API-Id header is required. Header keys are case sensitive.

Note: The ClaimStatusInquiry for dependents is the same for self. However, it uses different data parameters.

ClaimStatusInquiry Request Fields for Self

Property Name	Data Type	Usage	Description
payerCode	String	Required	pVerify payer Code (i.e. Aetna 00001)
ProviderLastName	String	Optional	Provider Last Name
ProviderNPI	String	Conditional	10-digit NPI value (Not required when ProviderFederalTaxId is available)
ProviderFederalTaxId	String	Conditional	9 - digit Federal Tax Id (EIN) (not required when NPI is available)
payerClaimNumber	String	Conditional	Payer claim number
chargeAmount	String	Required	Charge Amount
serviceStartDate	String	Required	Start date of service (Expected format: MM/dd/YYYY ie 01/01/2000)
serviceEndDate	String	Required	End date of service (Expected format: MM/dd/YYYY ie 01/01/2000)
subscriber	Object	Required	Subscriber demographic information
subscriber.FirstName	String	Conditional	Subscriber first name
subscriber.lastName	String	Conditional	Subscriber last name
subscriber.dob	String	Conditional	Subscriber Date of Birth (Expected format: MM/dd/YYYY ie 01/01/2000)
subscriber.memberID	String	Conditional	Member ID of subscriber
subscriber.gender	String	Conditional	Gender of subscriber. Allowed M, F or O
isPatientDependent	boolean	Optional	Determines if the patient is dependent

ClaimStatusInquiry Request Fields for Dependents

Property Name	Data Type	Required	Description
payerCode	String	Yes	pVerify payer Code (i.e. Aetna 00001)
ProviderLastName	String	No	Provider Last Name
ProviderNPI	String	Conditional	10-digit NPI value (Not required when ProviderFederalTaxId is available)
ProviderFederalTaxId	String	Conditional	9 - digit Federal Tax Id (EIN) (not required when NPI is available)
payerClaimNumber	String	Conditional	Payer claim number
chargeAmount	String	Yes	Charge Amount
serviceStartDate	String	Yes	Start date of service (Expected format: MM/dd/YYYY ie 01/01/2000)
serviceEndDate	String	Yes	End date of service (Expected format: MM/dd/YYYY ie 01/01/2000)
subscriber	Object	Yes	Subscriber demographic information
subscriber.FirstName	String	Conditional	Subscriber first name
subscriber.lastName	String	Conditional	Subscriber last name
subscriber.dob	String	Conditional	Subscriber Date of Birth (Expected format: MM/dd/YYYY ie 01/01/2000)
subscriber.memberID	String	Conditional	Member ID of subscriber
subscriber.gender	String	Conditional	Gender of subscriber.Allowed M, F or O
isPatientDependent	boolean	No	Determines if the patient is dependent
dependent	Object	Conditional	Dependent demographic information
dependent.FirstName	String	Conditional	Dependent first name
dependent.lastName	String	Conditional	Dependent last name
dependent.dob	String	No	Dependent Date of Birth (Expected format: MM/dd/YYYY ie 01/01/2000)
dependent.gender	String	Conditional	Gender of Dependent.Allowed M, F or O

ClaimStatusInquiry Response Fields

\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n

Property Name	Data Type	Description
RequestID	Long	Claim Status Request ID
apiResponseCode	int	API transaction response code. Please see apiResponseCode table
apiResponseMessage	String	API transaction response message
ProcessedWithError	String	true when processed with error by the payer.
payerClaimNo	String	Payer Claim Number (if returned in EDI 277)
categoryCode	String	Category code of claim status
category	String	Category of claim status
claimStatusReasonCode	String	Claim Status Code
claimStatus	String	Claim status text
payer	Payer	Contains payer info
providerInfo	Info	Contains provider info
subscriber	Info	Contains Subscriber info
dependent	Info	Contains dependent info
ClaimStatuses	List	Contains Claim Status Info
ClaimStatuses.serviceLine	List	Contains Claim Service line item info, ie: Code specific info

The API Response Codes and there description are shown below.

\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n

APIResponseCode	Description
0	Processed
1	Rejected
2	NoFunds (insufficient account balance)
3	InvalidRequest (Required data missing)
4	InvalidFormat (data format or data fields are wrong)
5	InvalidPayer (Payer does not support Claim Status electronically / inactive)
6	LocationError (Location is not configured)

","urlObject":{"protocol":"https","path":["API","ClaimStatusInquiry"],"host":["api","pverify","com"],"query":[],"variable":[]}},"response":[],"_postman_id":"06a58c55-84f9-4fd7-b426-5ed126209025"},{"name":"GetClaimStatusResponse","id":"9041cf59-2440-4e9d-9cf7-bb28071b0d53","protocolProfileBehavior":{"disableBodyPruning":true},"request":{"method":"GET","header":[{"key":"Authorization","type":"text","value":"Bearer {{access-token}}"},{"key":"Client-API-Id","type":"text","value":"{{client-api-id}}"},{"key":"Content-Type","type":"text","value":"application/json"}],"url":"https://apis.pverify.com/API/GetClaimStatusResponse/53","description":"

\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n

Environment	URL
Test	https://testapi.pverify.com/API/GetClaimStatusResponse/{requestId}
Production	https://api.pverify.com/API/GetClaimStatusResponse/{requestId}

This GET method is used to obtain the transaction result later using a unique request ID. Note: the data is deleted after 90 days.

\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n

Field	Description
URL	https://api.pverify.com/API/GetClaimStatusResponse/{requestId}
Method	GET
Headers	Description
Authorization	Bearer XXX
Client-API-Id	client-api-id provided through pVerify
Content-Type	application/json
URL Parameters	Unique Request id
Data Parameters	None

A successful GetClaimStatusResponse call will have the same format as the ClaimStatusInquiry response (above).

\n","urlObject":{"protocol":"https","path":["API","GetClaimStatusResponse","53"],"host":["apis","pverify","com"],"query":[],"variable":[]}},"response":[],"_postman_id":"9041cf59-2440-4e9d-9cf7-bb28071b0d53"}],"id":"6c3e355f-ce49-4b7e-aaf0-384e94178971","description":"

pVerify has several RESTful APIs to give Claim Status information, given subscriber or dependent It would be a two step work flow.

ClaimStatus payer work flow

Generate Token
\n
Call ClaimStatusInquiry to submit a request to our queue to get the Claim Status
\n

In order to run a Claim Status call, it is first necessary to generate a token using the authorization call

\n","event":[{"listen":"prerequest","script":{"id":"3ba6eee3-47ae-4d04-a145-8cd037259c60","type":"text/javascript","exec":[""]}},{"listen":"test","script":{"id":"2fcdc49a-5ef5-4f84-8146-29c090183193","type":"text/javascript","exec":[""]}}],"_postman_id":"6c3e355f-ce49-4b7e-aaf0-384e94178971"},{"name":"Estimates","item":[{"name":"EstimateCalculation","id":"d5883eff-f4dd-43c9-936b-341a24807f08","protocolProfileBehavior":{"disableBodyPruning":true},"request":{"method":"POST","header":[{"key":"Authorization","value":"Bearer {{access-token}}","type":"text"},{"key":"Client-API-Id","value":"{{client-api-id}}","type":"text"},{"key":"Content-Type","value":"application/json","type":"text"}],"body":{"mode":"raw","raw":"{\r\n \"zipCode\": \"27713\",\r\n \"cptCodes\":[\"10061\",\"0191T\", \"33300\"],\r\n \"coPay\":\"20\",\r\n \"coinsPercentage\":\"30\",\r\n \"deductibleRemaining\":\"40\",\r\n \"outofPocketRemaining\": \"\",\r\n \"isCopayIncludeInDeductible\":false,\r\n \"isSecondryStatusActive\":false,\r\n \"NonMedicareMultipleFactor\":1.2,\r\n \"InternalId\":null\r\n}"},"url":"https://api.pverify.com/api/EstimateCalculation","description":"

\n\n\n\n\n\n\n\n\n\n\n\n\n

Environment	URL
Production	https://api.pverify.com/api/EstimateCalculation

This POST call will get an estimated price from CMS (Medicare) non-facility price index. In order for you to use this, we must add the estimator service (which is free) to your account. Additionally, for the Zip code, use 0 for national pricing, and you can send an array of CPT codes per the Postman example. Please note, due to the nature of the EstimateCalculation call, no test credentials are available.

EstimateCalculation Request

\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n

Key	Value
URL	https://api.pverify.com/api/EstimateCalculation
Method	POST
Headers	Description
Client-API-Id*	Your pVerify client-api-id
Content-Type	application/json
Body	Description
Data Parameters	See fields to the right

*Note: The Client-API-Id is required in header. Header keys are case sensitive.

EstimateCalculation Request Fields

\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n

Field	Type	Description
zipCode	String	Zip code of your location. Use 0 for national pricing.
cptCodes	String	Array of CPT codes needed for estimate. If there is a modifier include it as a dash. For example, 93024-TC would be the cardiac drug stress test technical component.
coPay	String	Dollar amount of patient copay.
coinsPercentage	String	In percent, coinsurance
deductibleRemaining	String	Dollar amount of deductible remaining
outofPocketRemaining	String	Out of pocket remaining- if this is blank we will not include this in the calculation.
isCopayIncludeInDeductible	Boolean	Add copay to coinsurance or not.
isSecondaryStatusActive	Boolean	If patient has secondary insurance- if this is true then patient responsibility is zero.
NonMedicareMultipleFactor	Decimal	NonMedicare Multiple factor to CPT values calculation
InternalId	String	Internal Id for patient

EstimateCalculation Response

\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n

Field	Description
patientResponsibility	The amount the patient owes.
copay	Patient copay.
coInsPercentage	Coinsurance percentage.
coInsAmount	Coinsurance Amount.
estimatedAllowable	THe sum of the charges (note: not all charges are approved by CMS)
deductibleRemainging	Amount of deductible remaining.+
outOfPocketRemaining	Amount remaining for out of pocket.++
amountPayable	Amount Payable
selected CPTs	Selected CPT codes
zipCode	Zip code returned
apiResponseCode	API response code
apiResponseMessage	API response message
InternalId	Internal Id for patient

+The deductible must be met before insurance applies. For example, if the deductible remaining is 1000, then the patient will have to pay out of pocket $1000 for next procedure as long as the procedure amount > $1000.
++This is typically a high number. Once it reaches zero, the patient responsibility is zero. It is designed for catastrophic coverage ie: major surgery or chemotherapy.

\n","urlObject":{"protocol":"https","path":["api","EstimateCalculation"],"host":["api","pverify","com"],"query":[],"variable":[]}},"response":[],"_postman_id":"d5883eff-f4dd-43c9-936b-341a24807f08"}],"id":"e299c681-6132-4c00-ad79-a571628ae521","description":"

pVerify has two RESTful API end points to provide CGX information,\nThe workflow is:

Get Token via Token call,
Call CGXInquiry and pass the token along with demographic information.

Note** : Same Token can be used in subsequent inquiries.

\n","event":[{"listen":"prerequest","script":{"id":"2cba9519-131c-4fbd-bd5c-2537fca7e2a1","type":"text/javascript","exec":[""]}},{"listen":"test","script":{"id":"13128ba0-84a1-47fe-ac24-9175e1c8125f","type":"text/javascript","exec":[""]}}],"_postman_id":"e299c681-6132-4c00-ad79-a571628ae521"},{"name":"CMN","item":[{"name":"CMNInquiry","id":"deb9000d-6025-4c54-896c-dbd8a294be65","protocolProfileBehavior":{"disableBodyPruning":true},"request":{"method":"POST","header":[{"key":"Authorization","value":"Bearer {{access-token}}","type":"text"},{"key":"Client-API-Id","value":"{{client-api-id}}","type":"text"},{"key":"Content-Type","value":"application/json","type":"text"}],"body":{"mode":"raw","raw":"{\r\n\"memberId\": \"123456\",\r\n\"patientFirstName\": \"First Name\",\r\n\"patientLastName\": \"Last Name\",\r\n\"patientDOB\": \"Date of birth\",\r\n\"patientStateCode\": \"StateCode\",\r\n\"hcpcsCode\": \"A, B, E, or K code\",\r\n\"dosStart\": \"12/09/2020\", \r\n\"dosEnd\": \"12/09/2020\", \r\n\"location\": \"location Name\",\r\n\"callBackUrl\":\"http://www.test.com/api/PostData\"\r\n}","options":{"raw":{"language":"json"}}},"url":"https://api.pverify.com/API/CMNInquiry","description":"

\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n

Environment	URL
Test	https://testapi.pverify.com/API/CMNInquiry
Production	https://api.pverify.com/API/CMNInquiry

\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n

Key	Value
URL	https://api.pverify.com/API/CMNInquiry
Method	POST
Headers	Description
Content-Type	application/json
Authorization	Authorization token from above preceded by the String \"Bearer\"
Client-API-Id*	Your pVerify client-api-id
Body	Description
Data Parameters	See Right Panel

*Note: The Client-API-Id is required in header. Header keys are case sensitive.

CMNInquiry Request fields

\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n

Property Name	Data Type	Usage	Description
memberId	String	Required	Patient's member ID (HICN).
patientFirstName	String	Required	Patient First Name.
patientLastName	String	Required	Patient Last Name.
patientDOB	String	Required	Patient DOB (Expected format: MM/dd/YYYY ie 01/01/2000).
patientStateCode	String	Required	Patient State Code ex: AL.
hcpcsCode	String	Required	HCPCS -L codes only. Multiple codes can be sent by separating with a comma (,).
dosStart	String	Optional	Date of service start date (Expected format: MM/dd/YYYY ie 01/01/2000). Default value is 5 years before date to current date.
dosEnd	String	Optional	Date of service end date (Expected format: MM/dd/YYYY ie 01/01/2000). Default value is current date (Today's date).
location	String	Optional	Location name and the default is client user's location or client's location.
callBackUrl	String	Optional	to Post response data on client side

APIResponseCode Meaning

\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n

APIResponseCode	Description
0	Processed
1	Rejected
2	NoFunds (Insufficient Account Balance)
3	Pending (Pending need to get response later)
4	InvalidRequest (Required Data Missing)
5	InvalidFormat (data fields / data format is wrong)
6	LocationError (Location is not configured)

** Response JSON Processing Steps **

Step 1: Check the value of the API Response Code property. If the API Response Code is 3 (Pending) then the request is pending and the Request ID can be extracted.

Step 2: Save the data

Note: The CMN API always returns API response code as 3 (pending)

\n","urlObject":{"protocol":"https","path":["API","CMNInquiry"],"host":["api","pverify","com"],"query":[],"variable":[]}},"response":[],"_postman_id":"deb9000d-6025-4c54-896c-dbd8a294be65"},{"name":"GetCMNResponse","id":"1b347d13-61e5-41cb-8523-2fd48804b9f3","protocolProfileBehavior":{"disableBodyPruning":true},"request":{"method":"GET","header":[{"key":"Authorization","value":"Bearer {{access-token}}","type":"text"},{"key":"Client-API-Id","value":"{{client-api-id}}","type":"text"},{"key":"Content-Type","value":"application/json","type":"text"}],"url":"https://api.pverify.com/API/GetCMNResponse/8","description":"

\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n

Environment	URL
Test	https://testapi.pverify.com/API/GetCMNResponse/{requestID}
Production	https://api.pverify.com/API/GetCMNResponse/{requestID}

This call is used to get the transaction result later using a unique request ID.

Note: We purge this data after 90 days

\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n

Key	Value
URL	https://api.pverify.com/API/GetCMNResponse/{requestID}
Method	GET
Headers	Description
Content-Type	application/json
Authorization	Authorization token from above preceded by the String \"Bearer\"
Client-API-Id*	Your pVerify client-api-id

*Note: The Client-API-Id header is required. Header keys are case sensitive.

Notes

Always check for apiResponseCode property value before processing.
\n
If APIResponseCode is zero then look for ErrorMessage and Claims to process response.
\n

A successful GetSameOrSimilarResponse will have the same format as the SameOrSimilarInquiry response.

API Response Codes

\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n

APIResponseCode	Description
0	Processed
1	Rejected
2	NoFunds (Insufficient Account Balance)
3	Pending (Pending need to get response later)
4	InvalidRequest (Required Data Missing)
5	InvalidFormat (data fields / data format is wrong)
6	LocationError (Location is not configured)

CMN Response Details

Property Name	Data Type	Description
RequestId	long	Same or Similar Request ID.
apiResponseCode	int	API transaction response code. Please see apiResponseCodes section.
apiResponseMessage	String	API transaction response message.
isDataError	boolean	True - when invalid patient details (Invalid HICN/MBI or Invalid DOB); False - for all valid requests.
CertificatesCount	int	No of certiifcates found in response
Message	String	Contains messages other than error messages (No claims found).
Status	String	Status of transaction (Processed, Rejected or Pending).
RentalsDescription	String	Oxygen Rentals Description.
IsVerifiedAllJusrisdiction	Boolean	Tells the transaction is verified in all Jurisdiction or not.If value false then need to get response using same API later.
VerifiedJurisdcitions	String Array	Contians Verified jurisdictions.
Certificates	List
	Contains claim certificates status info.
Certificate.SubmittedHcpcs	String	HCPCS Code Submitted in Request
Certificate.ApprovedHcpcs	String	HCPCS Code which is approved by Medicare
Certificate.InitialDate	String	Initial Date of Billing
Certificate.RevisedDate	String	Revised Date for CMN, if any.
Certificate.LastClaimDate	String	Date on which Last claim is recorded.
Certificate.Status	String	Status of Certificate. Valid / Open
Certificate.SupplierName	String	Supplier Name.
Certificate.SupplierPhone	String	Supplier Phone Number
Certificate.TypeValue	String	Type – Initial, Recert or Revised.
Certificate.LengthOfNeed	String	Length for which CMN is approved.
Certificate.TotalRentalPayments	Total Rental Payments
Certificate.Message	String	Contains Message like No Certificates are found.

","urlObject":{"protocol":"https","path":["API","GetCMNResponse","8"],"host":["api","pverify","com"],"query":[],"variable":[]}},"response":[],"_postman_id":"1b347d13-61e5-41cb-8523-2fd48804b9f3"},{"name":"CMN Report","id":"0c3b86d6-0e3e-48f0-b536-20ead278ca99","protocolProfileBehavior":{"disableBodyPruning":true},"request":{"method":"GET","header":[{"key":"Content-Type","value":"application/json","type":"text"},{"key":"Client-API-Id","value":"xxx","type":"text"},{"key":"Client-Secret","value":"xxx","type":"text"}],"url":"https://premium.pverify.com/PDFReport/CMN/{id}","description":"

This returns a PDF report of the CMN request.

Note two things:

The endpoint is premium.pverify.com
\n
Authentication token is not used, instead pass your API ID and Secret.
\n

\n","urlObject":{"protocol":"https","path":["PDFReport","CMN","{id}"],"host":["premium","pverify","com"],"query":[],"variable":[]}},"response":[],"_postman_id":"0c3b86d6-0e3e-48f0-b536-20ead278ca99"}],"id":"464faab0-4916-4c36-a55a-49c2bd5b779a","description":"

pVerify has two RESTful API end points to give CMN (A,B,E or K codes) Status information,

This workflow is:

Get Token via Token call,
\n
Call CMNInquiry and pass the token along with demographic information.
\n
Call GetSameOrSimilarResponse/{requestId} later to get the results and pass the token.
\n

Note : Same Token can be used in subsequent inquiries.

The JSON Viewer URL

Credentials To use these calls, you will need to set up an account and be given a username & password or client-api-id & client-secret. Please contact the pVerify team for this information.

\n","event":[{"listen":"prerequest","script":{"id":"eba8cbf7-f0ff-4164-af37-a2b728bb9c57","type":"text/javascript","exec":[""]}},{"listen":"test","script":{"id":"f98acc59-38f9-48ea-a7b2-35118e96a0ba","type":"text/javascript","exec":[""]}}],"_postman_id":"464faab0-4916-4c36-a55a-49c2bd5b779a"},{"name":"MBI","item":[{"name":"MBIInquiry","id":"ddbb67c4-b856-4002-8acf-63e9e39fb186","protocolProfileBehavior":{"disableBodyPruning":true,"disabledSystemHeaders":{"content-type":true}},"request":{"method":"POST","header":[{"key":"Client-API-Id","value":"{{client-api-id}}","type":"text"},{"key":"Authorization","value":"Bearer {{auth-token}}","type":"text"},{"key":"Content-Type","value":"application/json","type":"text"}],"body":{"mode":"raw","raw":"{\r\n \"ProviderLastName\": \"ProviderLastName\",\r\n \"ProviderNPI\": \"1234567890\",\r\n \"PatientFirstName\": \"John\",\r\n \"PatientDOB\": \"07/15/1956\",\r\n \"PatientLastName\": \"Doe\",\r\n \"PatientSSN_or_HICN\": \"\",\r\n \"PatientSSN\": \"\",\r\n \"MRN\": \"1234\",\r\n \"Location\": \"\",\r\n \"Address\": {\r\n \"AddressLine1\": null,\r\n \"City\": null,\r\n \"State\": \"MD\",\r\n \"ZipCode\": null\r\n }\r\n}"},"url":"https://api.pverify.com/API/MBIInquiry","description":"

MBI Skip Mechanism:

A transaction will be skipped if another transaction with same parameters(First Name, Last Name, Date of Birth (DOB), State, and SSN) is run in the current Calander month that is Processed/Processed with valid error

MBI Request Fields

\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n

Property Name	Data Type	Usage	Description
PatientSSN	String	Deprecated	Patient’s SSN or HICN
PatientSSN_or_HICN	String	Required	Patient’s SSN or HICN
PatientFirstName	String	Required	Patient first name
PatientLastName	String	Required	Patient last name
PatientDOB	String	Required	Patient DOB in MM/dd/yyyy format
ProviderLastName	String	Required	Provider Last Name
ProviderNPI	String	Required	Provider NPI, format is 10 digits
MRN	String	Optional	Medical record number , 50 chars are allowed.
Address.AddressLine1	String	Optional	Patient Street Address
Address.City	String	Optional	Patient City
Address.State	String	Optional	Patient State
Address.ZipCode	String	Optional	Patient ZipCode

","urlObject":{"protocol":"https","path":["API","MBIInquiry"],"host":["api","pverify","com"],"query":[],"variable":[]}},"response":[],"_postman_id":"ddbb67c4-b856-4002-8acf-63e9e39fb186"},{"name":"GetMBIResponse","id":"8aa7d5b4-ad84-41cd-a9cf-148e6b0fccd4","protocolProfileBehavior":{"disableBodyPruning":true},"request":{"method":"GET","header":[{"key":"Client-API-Id","value":"{{client-api-id}}","type":"text"},{"key":"Authorization","value":"Bearer {{auth-token}}","type":"text"},{"key":"Content-Type","value":"application/json","type":"text"}],"url":"https://api.pverify.com/API/GetMBIResponse/{requestId}","description":"

This call is used to get the transaction result later using unique request id which is returned in MBIInquiry API call.

Sample Response

{   \n \"RequestId\": \"482672\",\n \"Status\":\"Processed\",\n\"ErrorMessage\": null,\n \"PatientSSN\": \"123XXXXXX\",\n\"PatientFirstName\": \"PatientFirstName\",\n\"PatientLastName\": \"PatientLastName\",\n\"PatientDOB\": \"mm/dd/yyyy\",\n\"MBI\": \"234XXXXXXXXX\",\n\"MRN\": \"123435\",\n\"PartAStatus\": \"Active\",\n\"PartBStatus\": \"Active\",\n\"PartADate\": \"02/01/2021\",\n\"PartBDate\": \"02/01/2021\",\n\"ExpiredDate\": null,\n\"MedicareReason\":\"\",\n\"APIResponseCode\": 0,\n\"APIResponseMessage\": \"Processed\",\n\"ProcessedWithError\":false,\n\"address\": {\n    \"city\": \"City\",\n    \"state\": \"MD\",\n    \"street\": \"310 main\",\n    \"zip\": \"12345\"\n  },\n\"recordCount\": \"1\",\n  \"score\": \"96\"\n}\n\n

","urlObject":{"protocol":"https","path":["API","GetMBIResponse","{requestId}"],"host":["api","pverify","com"],"query":[],"variable":[]}},"response":[],"_postman_id":"8aa7d5b4-ad84-41cd-a9cf-148e6b0fccd4"}],"id":"b1971619-bedc-4cba-b32f-4097bd12e70f","description":"

pVerify has two RESTful API end points to provide MBI information, a POST and a GET call. The POST call will attempt the MBI inquiry and will get a real-time response with information related to the MBI inquiry. The GET call can be used optionally to retrieve that same response from our database.

The workflow is:

Get Token via Token call.
\n
Call MBIInquiry and pass the token along with demographic information.
\n
Optionally use the GET call to retrieve the POST response.
\n

Note** : Same Token can be used in subsequent inquiries.

\n","_postman_id":"b1971619-bedc-4cba-b32f-4097bd12e70f"},{"name":"Insurance Discovery","item":[{"name":"InsuranceDiscovery","id":"a8980dd4-58b0-4bce-9dd7-d6a2c15657b4","protocolProfileBehavior":{"disableBodyPruning":true},"request":{"method":"POST","header":[{"key":"Authorization","value":"Bearer {{access-token}}","type":"text"},{"key":"Client-API-Id","value":"{{client-api-id}}","type":"text"},{"key":"Content-Type","value":"application/json","type":"text"}],"body":{"mode":"raw","raw":"{\"doS_EndDate\":\"04/28/2023\",\"doS_StartDate\":\"04/28/2023\",\"patientStateId\":10,\"patientState\":\"\",\"patientSSN\":\"\",\"patientLastName\":\"TEST\",\"patientFirstName\":\"TEST\",\"patientDOB\":\"01/01/1950\",\"patientGender\":\"M\",\"location\":\"CA\",\"notes\":\"\", \"verifyMedicare\":false, \"patientHasDisability\":false }"},"url":"https://api.pverify.com/api/InsuranceDiscovery","description":"

\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n

Environment	URL
Test	https://testapi.pverify.com/API/InsuranceDiscovery
Production	https://api.pverify.com/API/InsuranceDiscovery

pVerify’s Insurance Discovery allows Hospitals and Providers to find a patient’s insurance coverage to collect potentially millions from insurance companies, allow prompt claim submission, increase patient payment collection, and drastically decrease Account Receivables.

Patient States
To run insurance discovery a patient state or patient state ID is required. As part of the setup, pVerify will work with you to create Patient States.

Headers

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Key	Value
URL	https://api.pverify.com/API/InsuranceDiscovery
Method	POST
Headers	Description
Authorization	Authorization token from above preceded by the String \"Bearer\"
Client-API-Id	API ID provided by pVerify
Content-Type	application/json

*Note: The Client-API-Id is required. Header keys are case sensitive.

InsuranceDiscovery Request Fields

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Property Name	Data Type	Usage	Description
patientStateId	Integer	Conditional	Please get it from pverify Team. Either patientSateId or patientState is required.
patientState	String	Conditional	Please get it from pverify Team. Either patientSateId or patientState is required.
patientFirstName	String	Required	First Name of patient required for inquiry
patientLastName	String	Required	Last Name of patient required for inquiry
patientDOB	String	Required	Required for self-inquiry for better matching result. (Expected format: MM/dd/YYYY ie 01/01/2000)
patientSSN	String	Conditional	SSN of Patient(To MBI lookup)
patientGender	String	Conditional	Gender will be mandatory for Medicaid patients
doS_StartDate	String	Required	Date of service start date (Expected format: MM/dd/YYYY ie 01/01/2000)
doS_EndDate	String	Required	Date of service end date (Expected format: MM/dd/YYYY ie 01/01/2000)
referenceId	String	Optional	Patient MRN or account Number
Notes	String	Optional	any free-text related patient
location	String	Required	Location is the practice location. Note by setting this, you will lock the patient to one location, so that users that login in via our portal who are not authorized to see that location will not see the patient.
verifyMedicare	Boolean	Optional	Default is false. If true, then Medicare transaction will takes place when the patient's age is >30 years.
patientHasDisability	Boolean	Optional	Default is false. If true, then Medicare transaction will takes place.

InsuranceDiscovery Response Fields

Key	Type	Description
RequestID	Integer	Eligibility Transaction ID
APIResponseCode	String	0-Processed,1-Rejected,2-NoFunds,3-Pending
APIResponseMessage	String	Message about the transaction
EDIErrorMessage	String	Message from Payer about errors
PayerName	String	Payer Name as defined by pVerify
PverifyPayerCode	String	Pverify Payer Code
ClientPayerName	String	It contains client practice payer map name to the pverify payer.
VerificationType	String	Verification Type –Subscriber or dependent
DOS	String	Date of service start date – DOS end date
IsHMOPlan	Boolean	If true then Patient has HMO plan
ExceptionNotes	String	Exception Notes if any. If response demographic info is not matched with that of Request
AddtionalInfo	String	If there is any other info
Location	String	Location in which trans ran
ReferrenceId	String	Referencid passed in request
ResultPracticeType	String	Practice type Name
AreAllSTCsProcessed*	Boolean	True when all service codes are processed by payer else false, This is helpful to determine to whether transaction needs to be reverify or not.
STCsStatusMessage*	String	Contains message when AreAllSTCsProcessed=false. Message contains list of not processed service codes
Notes	String
DemographicInfo	Object	It contains the subscriber info or dependent info .
ServiceDetails	Object	It contains all Service type details info
PreventiveServices	Object	Contains Preventive codes details
OtherPayerInfo	Object	It contains Other Payer info. It is null then there is no payer change.
PlanCoverageSummary	object	It contains Plan realted info.
PCPAuthInfoSummary	Object	It contains PCP auth info.
HBPC_Deductible_OOP_Summary	Object	It contains Deductible and OOP in from Health benefit Plan Coverage service type .It is null for Medicare Payer Inquiries.
MedicareInfoSummary	Object	It contains Medicare info summary. It is null for other payers and other summary details are empty for Medicare payer transaction.
SpecialistOfficeSummary	PracticeTypeSummary	It contains Specialist Consultation specific Summary (Co-Pay,Co-ins,Ded,OOP) and exclusive values of practice type .
ComboPayerResponses	Array of Object	It conatins Combo Group payer responses.. This response has been appended with Address,DOB,FullName,MemberId.
ComboPayerResponses.Address	String	It contains Address
ComboPayerResponses.DOB	String	It contains DOB
ComboPayerResponses.FullName	String	It contains FullName
ComboPayerResponses.MemberId	String	It contains MemberId
ComboPayerResponses.City	String	It contains City
ComboPayerResponses.State	String	It contains State
ComboPayerResponses.Zip	String	It contains Zip
MiscellaneousInfoSummary	Object

","urlObject":{"protocol":"https","path":["api","InsuranceDiscovery"],"host":["api","pverify","com"],"query":[],"variable":[]}},"response":[],"_postman_id":"a8980dd4-58b0-4bce-9dd7-d6a2c15657b4"},{"name":"InsuranceDiscovery GET","id":"bea7d441-f998-4d72-8e50-7858b027bcb1","protocolProfileBehavior":{"disableBodyPruning":true},"request":{"method":"GET","header":[{"key":"Authorization","type":"text","value":"Bearer {{access-token}}"},{"key":"Client-API-Id","type":"text","value":"{{client-api-id}}"},{"key":"Content-Type","type":"text","value":"application/json"}],"body":{"mode":"raw","raw":""},"url":"https://api.pverify.com/api/GetInusuranceDiscoverySummaryResponse/467","description":"

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Environment	URL
Test	https://testapi.pverify.com/API/GetInusuranceDiscoverySummaryResponse/{id}
Production	https://api.pverify.com/API/GetInusuranceDiscoverySummaryResponse/{id}

GetInusuranceDiscoverySummaryResponse returns the response from the InsuranceDiscovery POST call using a unique request id provided in the InsuranceDiscovery response.

Headers

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Key	Value
URL	https://api.pverify.com/API/GetInusuranceDiscoverySummaryResponse/{id}
Method	GET
Headers	Description
Authorization	Authorization token from above preceded by the String \"Bearer\"
Client-API-Id*	Your pVerify client-api-id
Client-API-Id	API ID provided by pVerify
Content-Type	application/json
URL Parameters	RequestId returned in InsuranceDiscovery response

*Note: The Client-API-Id header is required. Header keys are case sensitive.

GetInusuranceDiscoverySummaryResponse Response Fields

See InsuranceDiscovery response.

\n","urlObject":{"protocol":"https","path":["api","GetInusuranceDiscoverySummaryResponse","467"],"host":["api","pverify","com"],"query":[],"variable":[]}},"response":[],"_postman_id":"bea7d441-f998-4d72-8e50-7858b027bcb1"},{"name":"ID Details URL","id":"75555e77-f971-475a-9e83-868b8601ffdc","protocolProfileBehavior":{"disableBodyPruning":true},"request":{"method":"GET","header":[{"key":"Authorization","value":"Bearer {{access-token}}","type":"text"},{"key":"Client-API-Id","value":"{{client-api-id}}","type":"text"},{"key":"Content-Type","value":"application/json","type":"text"}],"url":"https://api.pverify.com/API/GetInsuranceDiscoveryDetailsURL/{requestID}","description":"

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Environment	URL
Test	/API/GetInsuranceDiscoveryDetailsURL/{id}
Production	/API/GetInsuranceDiscoveryDetailsURL/{id}

This GET method will return details URL with Insurance Discovery Request ID as a parameter.

GetInsuranceDiscoveryDetailsURL Request

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Key	Value
URL	/API/GetInsuranceDiscoveryDetailsURL/{id}
Method	GET
Headers	Description
Authorization	Authorization token from above preceded by the String \"Bearer\"
Client-API-Id*	Your pVerify client-api-id
Content-Type	application/json

*Note: The Client-API-Id header is required. Header keys are case sensitive.

GetInsuranceDiscoveryDetailsURL Resposne

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Key	Value
isDetailsURLGenerated	True or false
url	string URL
errorMessage	Message when isDetailsURLGenerated is false

JSON Response

{

\"isDetailsURLGenerated\": true,

\"url\": \"https://premium.pverify.com/Details\",

\"errorMessage\": null

}

\n","urlObject":{"protocol":"https","path":["API","GetInsuranceDiscoveryDetailsURL","{requestID}"],"host":["api","pverify","com"],"query":[],"variable":[]}},"response":[],"_postman_id":"75555e77-f971-475a-9e83-868b8601ffdc"},{"name":"Insurance Discovery Report","id":"a285b3a5-e70d-4ee9-8fd2-4b1957e11d55","protocolProfileBehavior":{"disableBodyPruning":true},"request":{"method":"GET","header":[{"key":"Content-Type","value":"application/json","type":"text"},{"key":"Client-API-Id","value":"xxx","type":"text"},{"key":"Client-Secret","value":"xxx","type":"text"}],"url":"https://premium.pverify.com/PDFReport/InsuranceDiscovery/{id}","description":"

This returns a PDF report of the Insurance Discovery request.

Note two things:

The endpoint is premium.pverify.com
\n
Authentication token is not used, instead pass your API ID and Secret.
\n
Replace {id} with the requestid you receive from the Insurance Discovery request.
\n

\n","urlObject":{"protocol":"https","path":["PDFReport","InsuranceDiscovery","{id}"],"host":["premium","pverify","com"],"query":[],"variable":[]}},"response":[],"_postman_id":"a285b3a5-e70d-4ee9-8fd2-4b1957e11d55"}],"id":"09aaf422-3c18-4193-90d4-c7ae5b78b423","_postman_id":"09aaf422-3c18-4193-90d4-c7ae5b78b423","description":""},{"name":"pDV - Patient Finder","item":[{"name":"PatientFinderInquiry","id":"4912a49d-88ad-44f1-88bb-abd1bf1c716c","protocolProfileBehavior":{"disableBodyPruning":true},"request":{"method":"POST","header":[{"key":"Authorization","value":"Bearer {{access-token}}","type":"text"},{"key":"Client-API-Id","value":"{{client-api-id}}","type":"text"},{"key":"Content-Type","value":"application/json","type":"text"}],"body":{"mode":"raw","raw":"{\r\n\t\"FirstName\": \"firstname\",\r\n\t\"MiddleName\": null,\r\n\t\"LastName\": \"lastname\",\r\n\t\"DOB\": null, // use format MM/DD/YYYY\r\n\t\"SSN\": null, // use format XXX-XX-XXXX\r\n\t\"PhoneNumber\": null,\r\n\t\"Address\": {\r\n\t\t\"AddressLine1\": \"Address1\",\r\n\t\t\"AddressLine2\": null,\r\n\t\t\"City\": \"City\",\r\n\t\t\"State\": \"ST\", // use abbreviation - CA for California\r\n\t\t\"ZipCode\": \"12345\"\r\n\t},\r\n\t\"Location\": \"Somewhere\",\r\n\t\"ReferenceNumber\": null // MRN etc\r\n}"},"url":"https://api.pverify.com/api/PatientFinderInquiry","description":"

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Environment	URL
Test	https://testapi.pverify.com/API/PatientFinderInquiry
Production	https://api.pverify.com/API/PatientFinderInquiry

Description:
Returns only the top matching patient based on provided demographic information. This endpoint is optimized for use cases where only the most likely match is needed.

Use Cases:
Fast lookups for integrations where a single high-confidence match is sufficient.
Scenarios where presenting a list of potential matches is not required.

Behavior:
Returns a maximum of 1 patient record (the best match).
Uses match score to determine the top candidate.
Ideal for a specific patient match.

Headers

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Key	Value
URL	https://api.pverify.com/API/PatientFinderInquiry
Method	POST
Headers	Description
Authorization	Authorization token from above preceded by the String \"Bearer\"
Client-API-Id	API ID provided by pVerify
Content-Type	application/json

*Note: The Client-API-Id is required. Header keys are case sensitive.

Search Criterias

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SNo	Search Criteria
1	FirstName,LastName,Street Address,City,State
2	FirstName,LastName,DOB,City,State
3	FirstName,LastName,DOB,State
4	LastName,DOB,Street Address,Zip Code
5	FirstName,LastName, Last 4 SSN
6	FirstName,LastName, Full SSN
7	FirstName,LastName, Zip Code
8	FirstName,LastName, State

PatientFinderInquiry Request Fields

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Property Name	Data Type	Usage	Description
FirstName	String	Optional	First Name of patient for inquiry
MiddleName	String	Optional	Middle Name of patient for inquiry
LastName	String	Required	Last Name of patient required for inquiry
DOB	String	Optional	(Expected format: MM/dd/YYYY ie 01/01/2000)
SSN	String	Optional	Social Security Number (Exported format XXX-XX-XXXX)
Address.AddressLine1	String	Optional	Address1
Address.AddressLine2	String	Optional	Address2
Address.City	String	Optional	City
Address.State	String	Optional	State
Address.ZipCode	String	Optional	Zip
Location	String	Required	Location is the practice location. Note by setting this, you will lock the patient to one location, so that users that login in via our portal who are not authorized to see that location will not see the patient.
ReferenceNumber	String	Optional	Any free text for patient identifier, ie MRN

PatientFinderInquiry Response Fields

Key	Type	Description
RequestID	Integer	Eligibility Transaction ID
APIResponseCode	Integer	0-Processed,1-Rejected,2-NoFunds,3-Pending
APIResponseMessage	String	Message about the transaction
Error	String	Message from Payer about errors
patientsFound	Integer	Number of patients found
RequestHasSSN	Boolean	True if request has SSN
IsMBIRegistered	Boolean	True if the request contains a registered MBI; otherwise, false
IsTRHasError	Boolean	True if there was an error during Thomson Reuters (TR) verification; otherwise, false
IsShowSSN	Boolean	Indicates whether the patient's SSN should be displayed in the response. True = show SSN, False = mask SSN
Patients	Array of Object	Returns the top-matched patient based on the request. (Note: Patients is an array, but it contains only one patient.)
Patients.FirstName	String	First name (Note Patients object is an array)
Patients.LastName	String	Last Name
Patients.MiddleName	String	Middle name
Patients.DOB	String	ODB
Patients.SSN	String	SSN (this is masked unless request has SSN)
Patients.RecordCount	Integer	Number of records with this information (usually
Patients.Score	Integer	From 1-99, higher is better. >90 is typical for a very likely chance of exact match
Patients.GroupId	String	GroupId
Patients.Emails	String	(not supported yet)
Patients.Address	Object	Address object as request
Patients.Address.AddressLine1	String	Address1
Patients.Address.AddressLine2	String	Address2
Patients.Address.City	String	City
Patients.Address.State	String	State
Patients.Address.ZipCode	String	Zip
Patients.Address.ReportedDate	String	The date on which the patient's record was last updated.
Patients.PhoneNumber	String	(not supported yet)

","urlObject":{"protocol":"https","path":["api","PatientFinderInquiry"],"host":["api","pverify","com"],"query":[],"variable":[]}},"response":[],"_postman_id":"4912a49d-88ad-44f1-88bb-abd1bf1c716c"},{"name":"PatientFinderInquiryResults","id":"c1603c25-229f-4bc1-b79f-232b0723526b","protocolProfileBehavior":{"disableBodyPruning":true},"request":{"auth":{"type":"noauth","isInherited":false},"method":"POST","header":[{"key":"Authorization","value":"Bearer {{access-token}}","type":"text"},{"key":"Client-API-Id","value":"{{client-api-id}}","type":"text"},{"key":"Content-Type","value":"application/json","type":"text"}],"body":{"mode":"raw","raw":"{\r\n\t\"FirstName\": \"JOHN\",\r\n\t\"MiddleName\": null,\r\n\t\"LastName\": \"WILLIAMS\",\r\n\t\"DOB\": \"07/12/1938\", \r\n\t\"SSN\": null, \r\n\t\"PhoneNumber\": null,\r\n\t\"Address\": {\r\n\t\t\"AddressLine1\": null,\r\n\t\t\"AddressLine2\": null,\r\n\t\t\"City\": null,\r\n\t\t\"State\": null, \r\n\t\t\"ZipCode\": null\r\n\t},\r\n\t\"Location\": null,\r\n\t\"ReferenceNumber\": null ,\r\n \"SearchCriteriaId\":null\r\n}\r\n"},"url":"https://api.pverify.com/API/PatientFinderInquiryResults","description":"

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Environment	URL
Test	https://testapi.pverify.com/API/PatientFinderInquiryResults
Production	https://api.pverify.com/API/PatientFinderInquiryResults

Description:
Returns all matching patient records based on the search criteria. This endpoint is intended for workflows that require presenting multiple potential matches for verification.

Use Cases:
Used in Patient Validator-Verification.

Behavior:
Returns all matched patient records that meet the criteria.

Headers

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Key	Value
URL	https://api.pverify.com/API/PatientFinderInquiryResults
Method	POST
Headers	Description
Authorization	Authorization token from above preceded by the String \"Bearer\"
Client-API-Id	API ID provided by pVerify
Content-Type	application/json

*Note: The Client-API-Id is required. Header keys are case sensitive.

PatientFinderInquiryResults Request Fields

\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n

Property Name	Data Type	Usage	Description
FirstName	String	Optional	First Name of patient for inquiry
MiddleName	String	Optional	Middle Name of patient for inquiry
LastName	String	Required	Last Name of patient required for inquiry
DOB	String	Optional	(Expected format: MM/dd/YYYY ie 01/01/2000)
SSN	String	Optional	Social Security Number (Exported format XXX-XX-XXXX)
Address.AddressLine1	String	Optional	Address1
Address.AddressLine2	String	Optional	Address2
Address.City	String	Optional	City
Address.State	String	Optional	State
Address.ZipCode	String	Optional	Zip
Location	String	Required	Location is the practice location. Note by setting this, you will lock the patient to one location, so that users that login in via our portal who are not authorized to see that location will not see the patient.
ReferenceNumber	String	Optional	Any free text for patient identifier, ie MRN

PatientFinderInquiryResults Response Fields

Returns a list of all matched patients. All other response fields are the same as the PatientFinderInquiry endpoint.

Key	Type	Description
RequestID	Integer	Eligibility Transaction ID
APIResponseCode	String	0-Processed,1-Rejected,2-NoFunds,3-Pending
APIResponseMessage	String	Message about the transaction
Error	String	Message from Payer about errors
patientsFound	Integer	Number of patients found
RequestHasSSN	Boolean	True if request has SSN
IsMBIRegistered	Boolean	True if the request contains a registered MBI; otherwise, false
IsTRHasError	Boolean	True if there was an error during Thomson Reuters (TR) verification; otherwise, false
IsShowSSN	Boolean	Indicates whether the patient's SSN should be displayed in the response. True = show SSN, False = mask SSN
Patients	Array of Objects	Returns a list of matched patients based on the request. If only one patient is matched, the array will still contain a single object. (Note: Patients is always returned as an array.)
Patients.FirstName	String	First name
Patients.LastName	String	Last Name
Patients.MiddleName	String	Middle name
Patients.DOB	String	ODB
Patients.SSN	String	SSN (this is masked unless request has SSN)
Patients.RecordCount	Integer	Number of records with this information (usually
Patients.Score	Integer	From 1-99, higher is better. >90 is typical for a very likely chance of exact match
Patients.GroupId	String	GroupId
Patients.Emails	String	(not supported yet)
Patients.Address	Object	Address object as request
Patients.Address.AddressLine1	String	Address1
Patients.Address.AddressLine2	String	Address2
Patients.Address.City	String	City
Patients.Address.State	String	State
Patients.Address.ZipCode	String	Zip
Patients.Address.ReportedDate	String	The date on which the patient's record was last updated.
Patients.PhoneNumber	String	(not supported yet)

","urlObject":{"protocol":"https","path":["API","PatientFinderInquiryResults"],"host":["api","pverify","com"],"query":[],"variable":[]}},"response":[],"_postman_id":"c1603c25-229f-4bc1-b79f-232b0723526b"},{"name":"GetPatientFinderResponse","id":"674339a2-8b66-444a-b461-53d49660afe0","protocolProfileBehavior":{"disableBodyPruning":true},"request":{"method":"GET","header":[{"key":"Authorization","value":"Bear {{access-token}}","type":"text"},{"key":"Client-API-Id","value":"{{client-api-id}}","type":"text"},{"key":"Content-Type","value":"application/json","type":"text"}],"url":"https://api.pverify.com/API/GetPatientFinderResponse/0","description":"

\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n

Environment	URL
Test	https://testapi.pverify.com/API/GetPatientFinderResponse/{id}
Production	https://api.pverify.com/Test/API/GetPatientFinderResponse/{id}

This GET method will return complete response of PatientFinderInquiry endpoint. This call allows you to get the patient demographicverification result by a unique transaction ID.

GetPatientFinderResponse Request

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Key	Value
URL	https://api.pverify.com/API/GetEligibilityResponse/{id}
Method	GET
Headers	Description
Authorization	Authorization token from above preceded by the String \"Bearer\"
Client-API-Id*	Your pVerify client-api-id

*Note: The Client-API-Id header is required. Header keys are case sensitive.

A successful GetPatientFinderResponse call will have the same format as the Patient Finder Inquiry response (above).

\n","urlObject":{"protocol":"https","path":["API","GetPatientFinderResponse","0"],"host":["api","pverify","com"],"query":[],"variable":[]}},"response":[],"_postman_id":"674339a2-8b66-444a-b461-53d49660afe0"}],"id":"477ee60e-7ee6-4885-b41a-ace7b7a3aa29","_postman_id":"477ee60e-7ee6-4885-b41a-ace7b7a3aa29","description":""},{"name":"Misc","item":[{"name":"GetAllPayers","id":"fa05fefa-0d58-43fb-9723-ef981bd7b7b9","protocolProfileBehavior":{"disableBodyPruning":true},"request":{"method":"GET","header":[{"key":"Authorization","value":"Bearer {{access-token}}"},{"key":"Client-API-Id","value":"{{client-api-id}}"},{"key":"Content-Type","value":"application/json"}],"url":"https://api.pverify.com/API/GetAllPayers","description":"

\n\n\n\n\n\n\n\n\n\n\n\n\n

Environment	URL
Production	https://api.pverify.com/API/GetAllPayers

Returns the list of current pVerify payers (pVerify payer code & pVerify Payer Name). Note backoffice (non-EDI) payers are denoted with a payer code prefix of BO. For example BO00018

GetAllPayers Request

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Key	Value
URL	https://api.pverify.com/API/GetAllPayers
Method	GET
Headers	Description
Authorization	Authorization token from above preceded by the String \"Bearer\"
Client-API-Id*	Your pVerify client-api-id
Content-Type	application/json

*Note: The Client-API-Id header is required. Header keys are case sensitive.

GetAllPayers Response

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Key	Value
payerCode	Payer Code
payerName	Payer Name
isActive	Boolean determines if payer is active
isSupportingEligibility	Boolean determines if payer is supporting eligibility
isSupportingClaims	Boolean to see if payer is supporting claims
isEDIPayer	Boolean to see if payer is EDI

","urlObject":{"protocol":"https","path":["API","GetAllPayers"],"host":["api","pverify","com"],"query":[],"variable":[]}},"response":[],"_postman_id":"fa05fefa-0d58-43fb-9723-ef981bd7b7b9"},{"name":"GetPayerStatus","id":"d5059b99-e009-4787-8413-598a5e56493f","protocolProfileBehavior":{"disableBodyPruning":true},"request":{"method":"GET","header":[],"url":"https://api.pverify.com/api/GetPayerStatus","description":"

\n\n\n\n\n\n\n\n\n\n\n\n\n

Environment	URL
Production	https://api.pverify.com/API/GetPayerStatus

This GET call will return the status of all pVerify payers. You can call this endpoint with an optional parameter of payerStatus and it will return payers from that status. By default the endpoint returns all payers and statuses. This API call does not require authentication.

GetPayerStatus Request

\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n

Key	Value
URL	http://api.pverify.com/api/GetPayerStatus
Method	GET
URL Params	Description
GetPayerStatus	Allows you to return specific payer status from response
Headers	None (this API call does not require authentication)
Body	None

URL Parameters Description

\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n

Name	Description
Payer ok	We show this payer as active but do not have recent data from it.
Payer active	We show this payer as active and we have recent data from it.
Payer inactive	This is marked as inactive in our system.
Payer Down	This is marked as active but has within the last 1 hour returned data showing that it down

GetPayerStatus Response

\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n

Key	Value
payerName	Name of payer
payer_Code	Payer code
payerStatus	Payer Status (see URL parameters description)

","urlObject":{"protocol":"https","path":["api","GetPayerStatus"],"host":["api","pverify","com"],"query":[],"variable":[]}},"response":[],"_postman_id":"d5059b99-e009-4787-8413-598a5e56493f"},{"name":"Down Payer List","id":"9aca240b-585d-4eb9-a600-24dbda1a5b5a","protocolProfileBehavior":{"disableBodyPruning":true},"request":{"method":"GET","header":[],"url":"https://api.pverify.com/API/GetPayerStatusStatistics?status=Rejected&checkForLastNumberOfHours=1","description":"

This API will return an array of payers that are known to be temporarily down.

\n","urlObject":{"protocol":"https","path":["API","GetPayerStatusStatistics"],"host":["api","pverify","com"],"query":[{"key":"status","value":"Rejected"},{"key":"checkForLastNumberOfHours","value":"1"}],"variable":[]}},"response":[],"_postman_id":"9aca240b-585d-4eb9-a600-24dbda1a5b5a"}],"id":"950201fb-da4f-4724-a690-c4094270e294","_postman_id":"950201fb-da4f-4724-a690-c4094270e294","description":""},{"name":"Tables","item":[],"id":"27234fd2-af03-46b9-9e6d-12612cafd044","description":"

Payer Table

pVerify Payer Code List
Click here to view Payer List

Service Code Table

This is the pVerify service type code list, please use the service type code (first column) in your eligibility queries. Common eligibility information is in service type code 30, Health Benefit Plan Coverage.

NOTE: Used only for EligibilityInquiry endpoint. Please see Practice Type Codes for Eligibility Summary.

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STC	Name
1	[1] Medical Care
2	[2] Surgical
3	[3] Consultation
4	[4] Diagnostic X-Ray
5	[5] Diagnostic Lab
6	[6] Radiation Therapy
7	[7] Anesthesia
8	[8] Surgical Assistance
9	[9] Other Medical
10	[10] Blood Charges
11	[11] Used Durable Medical Equipment
12	[12] Durable Medical Equipment Purchase
13	[13] Ambulatory Service Center Facility
14	[14] Renal Supplies in the Home
15	[15] Alternate Method Dialysis
16	[16] Chronic Renal Disease (CRD) Equipment
17	[17] Pre-Admission Testing
18	[18] Durable Medical Equipment Rental
19	[19] Pneumonia Vaccine
20	[20] Second Surgical Opinion
21	[21] Third Surgical Opinion
22	[22] Social Work
23	[23] Diagnostic Dental
24	[24] Periodontics
25	[25] Restorative
26	[26] Endodontics
27	[27] Maxillofacial Prosthetics
28	[28] Adjunctive Dental Services
30	[30] Health Benefit Plan Coverage
32	[32] Plan Waiting Period
33	[33] Chiropractic
34	[34] Chiropractic Office Visits
35	[35] Dental Care
36	[36] Dental Crowns
37	[37] Dental Accident
38	[38] Orthodontics
39	[39] Prosthodontics
40	[40] Oral Surgery
41	[41] Routine (Preventive) Dental
42	[42] Home Health Care
43	[43] Home Health Prescriptions
44	[44] Home Health Visits
45	[45] Hospice
46	[46] Respite Care
47	[47] Hospital
48	[48] Hospital - Inpatient
49	[49] Hospital - Room and Board
50	[50] Hospital - Outpatient
51	[51] Hospital - Emergency Accident
52	[52] Hospital - Emergency Medical
53	[53] Hospital - Ambulatory Surgical
54	[54] Long Term Care
55	[55] Major Medical
56	[56] Medically Related Transportation
57	[57] Air Transportation
58	[58] Cabulance
59	[59] Licensed Ambulance Licensed Ambulance
60	[60] General Benefits
61	[61] In-vitro Fertilization
62	[62] MRI/CAT Scan
63	[63] Donor Procedures
64	[64] Acupuncture
65	[65] Newborn Care
66	[66] Pathology
67	[67] Smoking Cessation
68	[68] Well Baby Care
69	[69] Maternity
70	[70] Transplants
71	[71] Audiology Exam
72	[72] Inhalation Therapy
73	[73] Diagnostic Medical
74	[74] Private Duty Nursing
75	[75] Prosthetic Device
76	[76] Dialysis
77	[77] Otological Exam
78	[78] Chemotherapy
79	[79] Allergy Testing
80	[80] Immunizations
81	[81] Routine Physical
82	[82] Family Planning
83	[83] Infertility
84	[84] Abortion
85	[85] AIDS
86	[86] Emergency Services
87	[87] Cancer
88	[88] Pharmacy
89	[89] Free Standing Prescription Drug
90	[90] Mail Order Prescription Drug
91	[91] Brand Name Prescription Drug
92	[92] Generic Prescription Drug
93	[93] Podiatry
94	[94] Podiatry - Office Visits
95	[95] Podiatry - Nursing Home Visits
96	[96] Professional (Physician)
97	[97] Anesthesiologist
98	[98] Professional (Physician) Visit - Office
99	[99] Professional (Physician) Visit - Inpatient
A0	[A0] Professional (Physician) Visit - Outpatient
A1	[A1] Professional (Physician) Visit - Nursing Home
A2	[A2] Professional (Physician) Visit - Skilled Nursing Facility
A3	[A3] Professional (Physician) Visit - Home
A4	[A4] Psychiatric
A5	[A5] Psychiatric - Room and Board
A6	[A6] Psychotherapy
A7	[A7] Psychiatric - Inpatient
A8	[A8] Psychiatric - Outpatient
A9	[A9] Rehabilitation
AA	[AA] Rehabilitation - Room and Board
AB	[AB] Rehabilitation - Inpatient
AC	[AC] Rehabilitation - Outpatient
AD	[AD] Occupational Therapy
AE	[AE] Physical Medicine
AF	[AF] Speech Therapy
AG	[AG] Skilled Nursing Care
AH	[AH] Skilled Nursing Care - Room and Board
AI	[AI] Substance Abuse
AJ	[AJ] Alcoholism
AK	[AK] Drug Addiction
AL	[AL] Vision (Optometry)
AM	[AM] Frames
AN	[AN] Routine Exam
AO	[AO] Lenses
AQ	[AQ] Nonmedically Necessary Physical
AR	[AR] Experimental Drug Therapy
B1	[B1] Burn Care
B2	[B2] Bran Name Prescription Drug - Formulary
B3	[B3] Bran Name Prescription Drug - Non -Formulary
BA	[BA] Independent Medical Evaluation
BB	[BB] Partial Hospitalization (Psychiatric)
BC	[BC] Day Care (Psychiatric)
BD	[BD] Cognitive Therapy
BE	[BE] Massage Therapy
BF	[BF] Pulmonary Rehabilitation
BG	[BG] Cardiac Rehabilitation
BH	[BH] Pediatric
BI	[BI] Nursery
BJ	[BJ] Skin
BK	[BK] Orthopedic
BL	[BL] Cardiac
BM	[BM] Lymphatic
BN	[BN] Gastrointestinal
BP	[BP] Endocrine
BQ	[BQ] Neurology
BR	[BR] Eye
BS	[BS] Invasive Procedures
BT	[BT] Gynecological
BU	[BU] Obsterical
BV	[BV] Obsterical/Gynecological
BW	[BW] Mail Order Prescription Drug : Brand Name
BX	[BX] Mail Order Prescription Drug : Generic
BY	[BY] Physician Visit - Office : Sick
BZ	[BZ] Physician Visit - Office : Well
C1	[C1] Coronary Care
CA	[CA] Private Duty Nursing - Inpatient
CB	[CB] Private Duty Nursing - Home
CC	[CC] Surgical Benefits - professional (physician)
CD	[CD] Surgical Benefits - Facility
CE	[CE] Mental Health Provider - Inpatient
CF	[CF] Mental Health Provider - Outpatient
CG	[CG] Mental Health Facility - Inpatient
CH	[CH] Mental Health Facility - Outpatient
CI	[CI] Substance Abuse Facility - Inpatient
CJ	[CJ] Substance Abuse Facility - Outpatient
CK	[CK] Screening X - Ray
CL	[CL] Screening Laboratory
CM	[CM] Mammomogram, High Risk Patient
CN	[CN] Mammomogram, Low Risk Patient
CO	[CO] Flu Vaccination
CP	[CP] Eyewear And Eywear Accessories
CQ	[CQ] Case Management
DG	[DG] Dermatology
DM	[DM] Durable Medical Equipment
DS	[DS] Diabetic Supplies
GF	[GF] Generic Presciption Drug - Formulary
GN	[GN] Generic Presciption Drug - Non -Formulary
GY	[GY] Allergy
IC	[IC] Intesive Care
MH	[MH] Mental Health
NI	[NI] Neonatal Intesive Care
ON	[ON] Oncology
PT	[PT] Physical Therapy
PU	[PU] Pulmonary
RN	[RN] Renal
RT	[RT] Residential Psychiatric Treatment
TC	[TC] Transitional Care
TN	[TN] Transitional Nursery Care
UC	[UC] Urgent Care

Practice type table

Production Environment

This is the pVerify Practice Types available in production for EligiblitySummary endpoints. Practice Types are built around Service Type Codes.

ID	PracticeType
3	DME
8	Chemotherapy
9	VisionOptometry
12	Physical Therapy
17	Primary Care
18	Specialist - Office
21	Mental Health
22	Surgical -Office
23	Urgent Care
24	Diagnostic Lab
27	Specialist(Office)_Surgical(Office)_Diagnostic Lab
28	ASC Facility
30	Chiropractic
31	MRI/CAT Scan
32	X-Ray
33	Speech Therapy
34	Occupational Therapy
35	ASC_Specialist(Office)_VisionOptometry
36	Specialist(Office)_Chemotherapy
37	Physical Therapy_Chiropractic
38	Physical Therapy_DME
39	Physical Therapy_Occupational Therapy_DME
40	Physical Therapy_Occupational Therapy_Speech Therapy
41	Specialist(Office)_VisionOptometry
42	Specialist(Office)_DME
43	Specialist(Office)_Surgical(Office)
44	Specialist(Office)_ASC Facility
45	Physical Therapy_XRay
46	XRay_MRI/CAT Scan
53	Speech Therapy_Occupational Therapy
54	Emergency Services
55	Routine Physical
56	Podiatry Office
57	Professional - Outpatient Physician
58	Anesthesia
59	Substance Abuse
60	Substance Abuse Facility-InPatient
61	Substance Abuse Facility-OutPatient
62	Telemedicine
63	Flu Vaccination
64	Mental Health_Sub Abuse Professional
65	Mental Health_Sub Abuse_In&OutFacility
66	Sub Abuse_In&OutFacility
67	Mental Health_SubAbuse_In-NetFacility
68	Specialist(Office)_ASC_Professional OutPatient
69	ASC Facility_Professional OutPatient
70	General_Office_Benefits(30)
71	Podiatry_XRay_DME
72	Podiatry_DME
73	Hospital-InPatient
74	Emergency Services_Hospital-InPatient
75	Speech Therapy_Occupational Therapy_MentalHealth
76	DME_Diagnostic Lab
77	Pharmacy
78	Specialist(Office)_Pharmacy
79	Physical Therapy_Occupational Therapy_Mental Health
80	Specialist(Office)_DME_ASC Facility
81	Specialist(Office)_DME_Surgical(Office)
82	Specialist(Office)_DME_Hospital-OutPatient
83	Hospital-OutPatient
84	Physical Therapy_Occupational Therapy
85	Specialist(Office)_Surgery(Office)_DME
87	SpecialistOffice_DME_X-Ray
88	SpecialistOffice_Physical Therapy
89	Telemedicine-Primary Care
90	Telemedicine-Specialist Services
91	Telemedicine-Urgent Care
92	Telemedicine-Physical Therapy
93	Telemedicine-Mental Health
94	Psychotherapy
95	Telemedicine Primary + Telemedicine Specialist
96	Telemedicine Primary + Telemedicine Specialist+Telemedicine Urgent care
97	Specialist(Office)_Psychotherapy
100	Hospital-Outpatient_Surgical(Office)_Specialist(Office)
101	SNF(AG)
102	SNF-Room_and_Board(AH)
103	SNF_SNF-Room_and_Board
104	Specialist(Office)_Mental Health
105	Specialist(office)_Primary Care_Chiropractic
106	Occupational Therapy_DME
107	Professional (Physician) Visit - Inpatient(99)
108	Home Health Care(42)
109	Hospice(45)
110	Home Health (42)_Hospice (45)
111	Mental Health_Telemedicine- Mental Health (MH)
112	Allergies
113	Diagnostic Medical
114	Maternity
115	Immunizations
116	Primary Care_Diagnostic Lab
117	Routine Physical_Immunizations_Diagnostic Medical
118	Physical Therapy & Telemedicine physical therapy
119	Telemedicine-Occupational Therapy(AD)
120	Telemedicine-Speech Therapy(AF)
121	Occupational Therapy & Telemedicine Occupational Therapy
122	Speech Therapy & Telemedicine Speech Therapy
123	PrimaryCare_Immunizations_Diagnostic Lab
124	PrimaryCare_Immunizations_Diagnostic Medical
125	Physical Therapy_Mental Health
126	Radiation Therapy
127	Specialist(Office)_Chemotherapy_RadiationTherapy
130	Infertility(83)
131	Allergy Testing(79)
132	Specialist Office(98)_Allergy Testing(79)
133	Specialist Office(98)_Infertility(83)
134	In-vitro Fertilization(61)
135	In-vitro Fertilization(61)_Infertility(83)_Specialist Office(98)
136	Psychiatric (A4)
137	Mental Health_Telemedicine-Mental Health(MH)_Psychotherapy(A6)_Psychiatric (A4)
138	Primary Care (30)_Urgent Care (UC)_Diagnostic Lab (5)
139	SNF(AG)_SNF-RoomAndBoard(AH)_PhysicalTherapy(PT)
140	Acupuncture(64)
141	Acupuncture(64)_PhysicalTherapy(PT)
142	Gynecological(BT)
143	Obstetrical(BU)
144	Obstetrical/Gynecological(BV)
145	Family Planning(82)
146	Surgical Benefits-Professional Physician(CC)
147	Surgical Benefits-Facility(CD)
148	GeneralOfficeBenefits_Maternity
149	Dialysis(76)
150	Mental Health Facility-Outpatient(CH)
151	SpecialistOffice_DME_X-Ray_Surgical(office)
152	Mental Health_SubAbuse_Out Net Facility
153	Mental Health_Mental Health OP Facility _Sub_Abuse_In&Out Net Facility
154	Mental Health (MH)_Mental Health Facility Outpatient(CH)
155	Telemedicine-Primary Care (30)_Diagnostic Medical (73)_Allergy Testing (79)
156	Primary Care(30)_Routine Physical(81)
157	XRay (4)_VisionOptometry (AL)
158	Diagnostic Medical(73)_Allergy Testing(79)_Specialist Office Visit(98)
159	Acupuncture(64)_Allergies(GY)
160	Acupuncture(64)_Chiropractic (33)_Physical Therapy (PT)
161	Mental Health (MH)_Pharmacy (88)__Psychiatric (A4)Psychotherapy(A6)
162	Podiatry Office (93)_Specialist - Office (98)_Surgical Benefits-Professional Physician(CC)_Surgical -Office (2)
163	Occupational Therapy (AD)_Physical Therapy (PT)_SNF(AG)_Speech Therapy (AF)
164	Specialist - Office (98)_Surgical -Office (2)_VisionOptometry (AL)(*)
165	Chemotherapy (78)_DME (12)_Specialist - Office (98)
166	DME (12)_Pharmacy (88)(*)_SNF(AG)
167	Mental Health (MH)_Mental Health Facility-Outpatient(CH)_Professional - Outpatient Physician (A0)(*)
168	Diagnostic Lab (5)_Primary Care (30)_X-Ray (4)(*)
169	DME (12)_Pharmacy (88)(*)
171	Diagnostic Lab (5)_Telemedicine-Specialist Services(98)
172	Primary Care_Allergy Testing_Diagnostic Medical
173	Diagnostic Lab (5)_Telemedicine-Primary Care(30)
174	Chiropractic (33)_Physical Therapy (PT)_Specialist - Office (98)
175	Specialist - Office (98)_Surgical -Office (2)_VisionOptometry (AL)()_X-Ray (4)()
176	Mental Health (MH)_Primary Care (30)_Specialist - Office (98)
177	Diagnostic Medical(73)_Specialist - Office (98)_Surgical -Office (2)_VisionOptometry (AL)(*)
178	DME (12)_Home Health Care(42)(*)
179	Allergy Testing(79)_Diagnostic Lab
180	Diagnostic Lab (5)_Pharmacy (88)(*)
181	DME (12)_Specialist - Office (98)_Telemedicine-Specialist Services(98)
182	Mental Health Facility-Inpatient(CG)
183	MRI/CAT Scan(62)_Chemotherapy (78)_Diagnostic Lab (5)_Radiation Therapy (6)
184	Mental Health (MH)_Substance Abuse (AI)()_Substance Abuse Facility-InPatient (CI)()_Substance Abuse Facility-OutPatient (CJ)(*)
185	ASC Facility (13)_Surgical -Office (2)
186	ASC Facility (13)_Hospital-OutPatient (50)()_Professional - Outpatient Physician (A0)()_Specialist - Office (98)
187	Diagnostic Medical(73)_Specialist - Office (98)_VisionOptometry (AL)(*)
188	Hospital-InPatient (48)()_Hospital-OutPatient (50)()_Specialist - Office (98)_Surgical -Office (2)
189	ASC Facility (13)_Hospital-InPatient (48)()_Hospital-OutPatient (50)()_Surgical -Office (2)
190	Medically Related Transportation
191	Maternity(69)_Specialist - Office (98)

Test Environment

Practice Types available under test endpoint

\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n

ID	PracticeType
3	DME
12	Physical Therapy
18	Specialist OV-Professional Services
27	OV_DxLab_Sx(Office)
38	PT_DME
40	PT_OT_ST

","_postman_id":"27234fd2-af03-46b9-9e6d-12612cafd044"},{"name":"Widget / Eligibility and Estimates / CGX","item":[{"name":"Setup","id":"fd9a9e9a-bd27-4ed6-b376-8b7ab73e75e0","protocolProfileBehavior":{"disableBodyPruning":true},"request":{"method":"POST","header":[],"body":{"mode":"raw","raw":"{\r\n \"clientApiId\":\"xxxx-xxxx-xxxx-xxxx-xxxx-xxxx-xxxx\",\r\n \"clientSecret\":\"xxxxxxxxxxxxxxx\"\r\n}","options":{"raw":{"language":"json"}}},"url":"https://premium.pverify.com/Widget/Setup","description":"

Step 1 - Generate setupId to load widget in iframe

SetupId will be required to load the widget in iframe. SetupId can be generated using Client ID and Client Secret. To generate SetupId, pass Client ID and Client Secret to following endpoint
[POST] https://premium.pverify.com/Widget/Setup
e.g.

{\n\"clientApiId\":\"xxxx-xxxx-xxxx-xxxx-xxxx-xxxx-xxxx\",\n\"clientSecret\":\"xxxxxxxxxxxxxxx\"\n}\n\n

It will generate a SetupId something like this XXXXxxXX-XXXX-XxXX-XxXX-XXxxXXXXxXX.

Step 2 - Load iframe with following URL with setupId
If you want to integrate Estimation widget, then set URL of iframe as shown below
https://premium.pverify.com/Component/EstimateInquiry?SetupId=setupId

If you want to integrate Eligibility widget, then set URL of iframe as shown below
https://premium.pverify.com/Component/ElgInquiry?SetupId=setupId

Details about SetupId

1.Need to generate SetupId for each transaction

2.SetupId is valid for 10 mins

\n","urlObject":{"protocol":"https","path":["Widget","Setup"],"host":["premium","pverify","com"],"query":[],"variable":[]}},"response":[],"_postman_id":"fd9a9e9a-bd27-4ed6-b376-8b7ab73e75e0"},{"name":"CGXInquiry - Estimates and Eligibility Combo","id":"f7a0707b-c7c9-4fee-a3c1-5d2a36097261","protocolProfileBehavior":{"disableBodyPruning":true},"request":{"method":"POST","header":[{"key":"Authorization","type":"text","value":"Bearer {{access-token}}"},{"key":"Client-API-Id","type":"text","value":"{{client-api-id}}"},{"key":"Content-Type","type":"text","value":"application/json"}],"body":{"mode":"raw","raw":"{\r\n\t\"PayerCode\": \"00192\", // this is pVerify's code - either use this or PayerName\r\n \"PayerName\": \"United HC\", // this is your mapped name mapped through our system - contact pVerify for more info\r\n\t\"MemberId\": \"1234\",\r\n\t\"PatientFirstName\": \"John\",\r\n\t\"PatientLastName\": \"Doe\",\r\n\t\"PatientDOB\": \"01/01/2000\",\r\n \"Location\": \"Brooklyn\",\r\n\t\"AppointmentType\": \"MRI Brain\", // this is a list of CPT codes in our system\r\n \"CPTList\": [ \"77001\", \"77002\"], // either this or ApptType is used\r\n\t\"MRN\": \"1234\",\r\n \"IsActiveSecondry\": false, // optional\r\n \"SelfPay\": false, // optional\r\n \"PracticeTypeId\": 25 // optional\r\n}"},"url":"https://api.pverify.com/api/CGXInquiry","description":"

\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n

Environment	URL
Test	https://testapi.pverify.com/API/CGXInquiry
Production	https://api.pverify.com/API/CGXInquiry

CGXInquiry is our combined Eligibility & Estimate endpoint.

Note that only a handful of items are required. This allows very quick and easy coding to get a response. The NPI is hard coded to use the default NPI. The location can use the first/default location. Pricing is based either on payer/location specific pricing or the medicare price. If the former, then the CPT codes need to be imported into pVerify. If the later, then the location needs to have the state/ZIP code set, and the default medicare % needs to be set from Premium (Admin Setup). It is possible when configured to use remit data to power this estimate. The eligibility call is the same as the EligibilitySummary call. Either the practice type can be set from the body or it will use the default practice type set by client.

Headers

\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n

Key	Value
URL	https://api.pverify.com/API/CGXInquiry
Method	POST
Headers	Description
Authorization	Authorization token from above preceded by the String \"Bearer\"
Client-API-Id	API ID provided by pVerify
Content-Type	application/json

*Note: The Client-API-Id is required. Header keys are case sensitive.

CGXInquiry Request Details

\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n

Property Name	Data Type	Usage	Description
PayerCode	String	Conditional	pVerify Payer Code(ie Aetna 00001)
PayerName	String	Conditional	Your payer name mapped through our system (note either PayerCode or PayerName is required)
MemberId	String	Required	Member ID of Patient
PatientFirstName	String	Required	Patient first name
PatientLastName	String	Required	Patient last name
PatientDOB	String	Required	Format must be MM/DD/YYYY
Location	String	Optional	Name of location - used to set the appointment pricing
ZipCode	String	Optional	0 if default, else ZipCode - see notes below
AppointmentType	String	Conditional	Name of appointment
CPTList	Array of String	Conditional	List of CPT codes - String array. Either this or AppointmentType is required. If both are set, the CPTList is used.
MRN	String	Optional	MRN or reference of patient - not used by pVerify
IsActiveSecondry	Boolean	Optional	For use for estimate
SelfPay	Boolean	Optional	For estimate
PracticeTypeId	Integer	Optional	Please consult Practice Type Code table - sets which practice type to use, i.e. 12 for physical therapy, which will return an object with PT benefits in the results. If you do not select a practice type, the default for your account will be used. Contact pVerify for more info.

Either PayerCode (preference) or your Payer Name mapped through our system can be used. The system will use the PayerCode if not empty.

Location is optional, it will pull the default location if not set. The location is used to power the Medicare pricing which relies on Zip Code. To overrride this, set the ZipCode field. If the Location field is a location that does not exist, it will be created. Note if this happens, the first user in the system must be role ClientAdmin else the API will not set the user to the location correctly. If this happens then the API call fails.

EIther CPTList (string array) or AppointmentType (name) can be used. If both are present then CPTList will be used. This is used to pull the pricing and it's based on the following order.

IF CptLIst is used, then this is the pricing order in the system:

Remit Price (CPT/Payer specific) (based on EDI 835 data specific to client)
\n
Payer & CPT specific custom pricing (from your imported fee schedule)
\n
Payer & CPT specific medicare pricing (from your imported fee schedule)
\n
CPT specific custom pricing (from your imported fee schedule)
\n
Medicare custom pricing (from your imported fee schedule)
\n
Medicare pricing (from CMS)
\n

Note for #6 there is a client-wide medicare price that can be used to act as a multiplier for Medicare Pricing - it is set in Admin Profile from Premium.

If Appointment list is used - the pricing is the same as above except remit pricing is not factored in.

CGXInquiry Response Fields

Property Name	Data Type	Description
requestId	Integer	Primary Key
isDataError	Boolean	true if error
errorMessage	String	Error message
eligibilityRequestID	Integer	Primary Key for request
elgStatus	String	Active if patient's insurance is active
elgResponseMessage	String	Error from eligibility call
apiResponseCode	Integer	0 if no error
apiResponseMessage	String	Processed if no error
detailResponse.preAuthStatus	String	Not yet supported
detailResponse.paFrom	String	Not yet supported
detailResponse.locationName	String	Name of location from request
detailResponse.cptCode	String	CPT Code
detailResponse.co_ins_Percentage	String	Coinsurance
detailResponse.co_Pay	String	Copay
detailResponse.deductible_remaining	String	Deductible Remaining
detailResponse.out_of_Pocket_remaining	String	OOP Remaining
detailResponse.estimatedAllowable	String	Allowed amount from payer
detailResponse.EstPtResponsibilitywDeduc	String	Estimate for patient responsibility with Deductible
detailResponse.EstPtResponsibilitywoDeduc	String	Estimate for patient responsibility without Deductible
detailResponse.EstPtResponsibilityMessage	String	Patient Responsibility message
detailResponse.amountPayable	String	Amount due by patient

Response JSON:

StartFragment

{
\"requestId\": 299,
\"isDataError\": false,
\"errorMessage\": \" Location set by default location. \",
\"detailResponse\": {
\"preAuthStatus\": null,
\"paFrom\": null,
\"locationName\": null,
\"cptCode\": \"70553\",
\"co_ins_Percentage\": \"0\",
\"co_Pay\": \"225.00\",
\"deductible_remaining\": \"0.00\",
\"out_of_Pocket_remaining\": \"5470.00\",
\"estimatedAllowable\": \"391.93\",
\"EstPtResponsibilitywDeduc\": \"225.00\",
\"EstPtResponsibilitywoDeduc\": \"225.00\",
\"EstPtResponsibilityMessage\": \"\",
\"amountPayable\": \"225.00\"
},
\"eligibilityRequestID\": 13672,
\"elgStatus\": \"Active\",
\"elgResponseMessage\": null,
\"estimationId\": 0,
\"apiResponseCode\": 0,
\"apiResponseMessage\": \"Processed\"
}

\n","urlObject":{"protocol":"https","path":["api","CGXInquiry"],"host":["api","pverify","com"],"query":[],"variable":[]}},"response":[{"id":"6f3f0960-38a9-4612-861d-6d83da81a531","name":"CGXInquiry","originalRequest":{"method":"POST","header":[{"key":"Authorization","type":"text","value":"Bearer {{access-token}}"},{"key":"Client-API-Id","type":"text","value":"{{client-api-id}}"},{"key":"Content-Type","type":"text","value":"application/json"}],"body":{"mode":"raw","raw":"{\r\n\t\"PayerMapCode\": \"00192\",\r\n\t\"MemberId\": \"1234\",\r\n\t\"PatientFirstName\": \"John\",\r\n\t\"PatientLastName\": \"Doe\",\r\n\t\"PatientDOB\": \"01/01/2000\",\r\n \"Location\": \"Brooklyn\",\r\n\t\"AppointmentType\": \"MRI Brain\", \r\n\t\"MRN\": \"1234\",\r\n \"IsActiveSecondry\": false, // optional\r\n \"UseRemitData\": false, // optional\r\n \"SelfPay\": false, // optional\r\n \"PracticeTypeId\": 25 // optional\r\n}"},"url":"https://api.pverify.com/api/CGXInquiry"},"_postman_previewlanguage":null,"header":null,"cookie":[],"responseTime":null,"body":null}],"_postman_id":"f7a0707b-c7c9-4fee-a3c1-5d2a36097261"}],"id":"e6493cbf-b93a-4ea6-aab7-9a6ebe23ae1c","description":"

pVerify’s Widgets

Currently, pVerify has two widgets. First is Estimation (previously known as CGX) and another is Eligibility.\n2).We have designed a widget with the ability, so that clients can integrate it in their websites using iframe.\n3).https://sample.pverify.com/ This sample page is designed to demonstrate the integration of our widgets into client websites.\n4).https://sample.pverify.com/ This sample page is using Google reCAPTCHA v3, to prevent spam and other types of automated abuse,\nbut clients can go with a different approach like giving access to logged in users only.

\n\n","event":[{"listen":"prerequest","script":{"id":"53e2f7cc-4ccd-4b5c-8baf-9e3df9a1114e","type":"text/javascript","exec":[""]}},{"listen":"test","script":{"id":"2ff49deb-b435-4cde-86ee-7bf5afb5465b","type":"text/javascript","exec":[""]}}],"_postman_id":"e6493cbf-b93a-4ea6-aab7-9a6ebe23ae1c"}],"event":[{"listen":"prerequest","script":{"id":"a075ff9b-ec18-4189-8e4c-59fc7d650445","type":"text/javascript","exec":[""]}},{"listen":"test","script":{"id":"74098065-c0ee-48eb-b057-84132a35309b","type":"text/javascript","exec":[""]}}]}

Available Endpoints

Authentication

Eligibility

Estimates

Same or Similar

Skilled Nursing Facility

Claim Status

CGX

CMN

Payers

Medicare HCPCS codes

EligibilityInquiry Response

EligibilitySummary Response

Medicare SNF and Other Information

Backoffice Payers

EDI Payer Workflow

Backoffice Payer Workflow

Client Libraries and Sample Code

EligibilitySummary Request Details

EligibilitySummary Response Fields

GetEligibilitySummary Response Fields

EligibilityInquiry Request Fields

EligibilityInquiry Response Fields

EasyEligibility Request Fields

EasyEligibility Response

EasyEligibilitySummary Request Fields

EasyEligibilitySummary Response Fields

DentalEligibilitySummary Request Details

DentalEligibilitySummary Response details

DentalEligibilityBenefitSummary Request Details

DentalEligibilityBenefitSummary Response details

GetEligibilitySummary Response Fields

V2 DentalEligibilitySummary Request Details

DentalEligibilitySummary Response details

GetDentalEligibilitySummary Response Fields

SameOrSimilarInquiry Request fields

APIResponseCode Meaning

Same or Similar Response Details

Response JSON Processing Steps

API Response Codes

Field Descriptions

Same or Similar Response Details

SNF Codes Inquiry Request Fields

SNF Codes Inquiry Response Fields

GetSNFResponse Response Fields

ClaimStatusInquiry Request Fields for Self

ClaimStatusInquiry Request Fields for Dependents

ClaimStatusInquiry Response Fields

EstimateCalculation Request

EstimateCalculation Request Fields

EstimateCalculation Response

CMNInquiry Request fields

APIResponseCode Meaning

API Response Codes

CMN Response Details

MBI Request Fields

InsuranceDiscovery Request Fields

InsuranceDiscovery Response Fields

GetInusuranceDiscoverySummaryResponse Response Fields

Search Criterias

PatientFinderInquiry Request Fields

PatientFinderInquiry Response Fields

PatientFinderInquiryResults Request Fields

PatientFinderInquiryResults Response Fields

Payer Table

Service Code Table

Practice type table

Production Environment

Test Environment

CGXInquiry Request Details

CGXInquiry Response Fields

Steps to integrate widget using iframe