pVerify's REST API gives healthcare providers, billing services, and software vendors real-time access to patient eligibility, insurance discovery, claim status, and related transactions — all as simple JSON requests, with no X12 EDI parsing required on your end.
\nMost integrations begin with one of two calls:
\nEligibility — verify a patient's active coverage, benefits, and copays with a known payer. Covers medical and dental (see Dental Eligibility).
\nInsurance Discovery — find a patient's coverage when you don't yet know their payer or member ID.
\nFrom there, pVerify supports a broader set of tools for specific situations:
\nInsurance Discovery, MBI Lookup, and Patient Demographic Validator share the same underlying matching engine — that's why fields like match confidence and Medicare registration status appear consistently across them.
\nAll requests require a bearer token, obtained via /Token using your client credentials. See Authentication for details. The same token can be reused across subsequent calls until it expires in an hour.
Almost all payers respond immediately through EDI. Some connect through non-electronic channels and require a submit-then-retrieve workflow instead of an instant response. This only affects Eligibility — Dental Eligibility, Insurance Discovery, and MBI Lookup are always processed in real time (typically within seconds). You can check a payer's processing type via GetPayerStatus or GetAllPayers in Payers before submitting. To enable back-office Payers, you must contact pVerify support for setup.
Most endpoints follow the same pattern:
\nOne exception: Patient Cost Estimator has no test environment — it's production-only.
\nTest environment responses don't contain any PHI — they return representative data, so you can build and demo safely without real patient information in place. To open a sandbox environment, contact sales to request a demo: https://pverify.com/request-a-demo/
\nSeveral endpoints (Insurance Discovery, MBI Lookup, Patient Demographic Validator, Non EDI eligibility checks, Claim Status Inquiry) follow a submit-then-retrieve pattern: a POST call returns a request ID, and a corresponding GET call retrieves the result once it's ready. Response bodies generally report transaction-level issues via fields like ProcessedWithError, ErrorCode, and apiResponseCode rather than through HTTP error statuses alone — check these fields even on a successful HTTP response.
pVerify transactions involve Protected Health Information (PHI). Use the test environment for development and demos wherever one is available, and follow your organization's HIPAA compliance requirements when handling any real patient data returned by these APIs.
\n","schema":"https://schema.getpostman.com/json/collection/v2.0.0/collection.json","toc":[],"owner":"6948370","collectionId":"6ceb8797-50ff-42fd-98a3-64beefaa6c94","publishedId":"2s7ZE4NR6P","public":true,"customColor":{"top-bar":"FFFFFF","right-sidebar":"002B49","highlight":"028684"},"publishDate":"2026-09-14T13:36:19.000Z"},"item":[{"name":"Authentication","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":"Token Authorization Request
\n*Note: The Client-API-Id header is required. Header keys are case sensitive.
\nThe /Token response includes the following fields:
\n","urlObject":{"protocol":"https","path":["Token"],"host":["api","pverify","com"],"query":[],"variable":[]}},"response":[{"id":"bf1388f3-03de-4ff8-8b84-f2f0338516aa","name":"Success - Token issued","originalRequest":{"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":"| Environment | URL |\n| --- | --- |\n| Test | [https://testapi.pverify.com/Token](https://testapi.pverify.com/Token) |\n| Production | [https://api.pverify.com/Token](https://api.pverify.com/Token) |\n\n**Token Authorization Request**\n\n| **Header** | Description |\n| --- | --- |\n| Method | POST |\n| URL | [https://api.pverify.com/Token](https://api.pverify.com/Token) |\n| Content-Type | application/x-www-form-urlencoded |\n| URL Params | None |\n| **Body** | Description |\n| Data Params\\* | \"Client_Id=\" + clientID + \"&client_secret=\" + ClientSecret + \"&grant_type=client_credentials\" |\n\n\\*Note: The Client-API-Id header is required. Header keys are case sensitive.\n\nThe /Token response includes the following fields:\n\n| Field | Type | Description |\n| --- | --- | --- |\n| access_token | {string} | Authorization token unique to you which is used to verify your authorization for subsequent calls. |\n| token_type | {string} | this is the token type which will be included before the access token in your subsequent method calls. |\n| expires_in | {int} | This is the amount of time that your token is valid for (in seconds). |"},"status":"OK","code":200,"_postman_previewlanguage":"json","header":[{"key":"Content-Type","value":"application/json"}],"cookie":[],"responseTime":null,"body":"{\n \"access_token\": \"SAMPLE-TOKEN-DO-NOT-USE-a1b2c3d4e5f6g7h8i9j0k1l2m3n4o5p6q7r8s9t0\",\n \"token_type\": \"bearer\",\n \"expires_in\": 3600\n}\n"},{"id":"3f0225bf-4059-4a8b-bdcc-f40395e5bc44","name":"Error - Invalid client credentials","originalRequest":{"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":"| Environment | URL |\n| --- | --- |\n| Test | [https://testapi.pverify.com/Token](https://testapi.pverify.com/Token) |\n| Production | [https://api.pverify.com/Token](https://api.pverify.com/Token) |\n\n**Token Authorization Request**\n\n| **Header** | Description |\n| --- | --- |\n| Method | POST |\n| URL | [https://api.pverify.com/Token](https://api.pverify.com/Token) |\n| Content-Type | application/x-www-form-urlencoded |\n| URL Params | None |\n| **Body** | Description |\n| Data Params\\* | \"Client_Id=\" + clientID + \"&client_secret=\" + ClientSecret + \"&grant_type=client_credentials\" |\n\n\\*Note: The Client-API-Id header is required. Header keys are case sensitive.\n\nThe /Token response includes the following fields:\n\n| Field | Type | Description |\n| --- | --- | --- |\n| access_token | {string} | Authorization token unique to you which is used to verify your authorization for subsequent calls. |\n| token_type | {string} | this is the token type which will be included before the access token in your subsequent method calls. |\n| expires_in | {int} | This is the amount of time that your token is valid for (in seconds). |"},"status":"Bad Request","code":400,"_postman_previewlanguage":"json","header":[{"key":"Content-Type","value":"application/json"}],"cookie":[],"responseTime":null,"body":"{\n \"error\": \"Invalid_Credentials\",\n \"error_description\": \"The Client_Id and/or Client_Secret is incorrect or account is inactive.\"\n}\n"}],"_postman_id":"d84ac4d8-db8b-47bb-b5c7-5c61726c8466"}],"id":"966c44b5-9f9f-4b12-bb28-dc903f6bf70c","description":"Before calling any other pVerify endpoint, exchange your client credentials for an access token via the /Token endpoint. Include that token in the Authorization header of every subsequent request.
Method: POST
\nContent-Type: application/x-www-form-urlencoded
Client_Id={clientID}&client_secret={clientSecret}&grant_type=client_credentials
\nInclude the token in every subsequent request:
\nAuthorization: Bearer {access_token}\n\nReturns 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
\nGetAllPayers Request
\n*Note: The Client-API-Id header is required. Header keys are case sensitive.
\nGetAllPayers Response
\n","urlObject":{"protocol":"https","path":["API","GetAllPayers"],"host":["api","pverify","com"],"query":[],"variable":[]}},"response":[{"id":"4eb79d45-c1f9-4957-b121-03bc3e5d8294","name":"Success - Payer list","originalRequest":{"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":"| Environment | URL |\n| --- | --- |\n| Production | [https://api.pverify.com/API/GetAllPayers](https://api.pverify.com/API/GetAllPayers) |\n\nReturns 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\n\n**GetAllPayers Request**\n\n| Key | Value |\n| --- | --- |\n| URL | [https://api.pverify.com/API/GetAllPayers](https://api.pverify.com/API/GetAllPayers) |\n| Method | GET |\n| **Headers** | Description |\n| Authorization | Authorization token from above preceded by the String \"Bearer\" |\n| Client-API-Id\\* | Your pVerify client-api-id |\n| Content-Type | application/json |\n\n\\*Note: The Client-API-Id header is required. Header keys are case sensitive.\n\n**GetAllPayers Response**\n\n| Key | Value |\n| --- | --- |\n| payerCode | Payer Code |\n| payerName | Payer Name |\n| isActive | Boolean determines if payer is active |\n| isSupportingEligibility | Boolean determines if payer is supporting eligibility |\n| isSupportingClaims | Boolean to see if payer is supporting claims |\n| isEDIPayer | Boolean to see if payer is EDI |"},"status":"OK","code":200,"_postman_previewlanguage":"json","header":[{"key":"Content-Type","value":"application/json"}],"cookie":[],"responseTime":null,"body":"[\n {\n \"payerCode\": \"00001\",\n \"payerName\": \"Sample Payer One\",\n \"isActive\": true,\n \"isSupportingEligibility\": true,\n \"isSupportingClaims\": true,\n \"isEDIPayer\": true,\n \"isDentalPayer\": false,\n \"instructions\": \"\"\n },\n {\n \"payerCode\": \"00192\",\n \"payerName\": \"UHC\",\n \"isActive\": true,\n \"isSupportingEligibility\": true,\n \"isSupportingClaims\": false,\n \"isEDIPayer\": true,\n \"isDentalPayer\": false,\n \"instructions\": \"\"\n },\n {\n \"payerCode\": \"BO00018\",\n \"payerName\": \"Sample Back Office Payer\",\n \"isActive\": true,\n \"isSupportingEligibility\": true,\n \"isSupportingClaims\": false,\n \"isEDIPayer\": false,\n \"isDentalPayer\": false,\n \"instructions\": \"Requires portal login credentials on file with pVerify.\"\n }\n]\n"},{"id":"6d377d3e-535d-4c35-a3e1-b1b0c1165d04","name":"Error - Invalid access token","originalRequest":{"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":"| Environment | URL |\n| --- | --- |\n| Production | [https://api.pverify.com/API/GetAllPayers](https://api.pverify.com/API/GetAllPayers) |\n\nReturns 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\n\n**GetAllPayers Request**\n\n| Key | Value |\n| --- | --- |\n| URL | [https://api.pverify.com/API/GetAllPayers](https://api.pverify.com/API/GetAllPayers) |\n| Method | GET |\n| **Headers** | Description |\n| Authorization | Authorization token from above preceded by the String \"Bearer\" |\n| Client-API-Id\\* | Your pVerify client-api-id |\n| Content-Type | application/json |\n\n\\*Note: The Client-API-Id header is required. Header keys are case sensitive.\n\n**GetAllPayers Response**\n\n| Key | Value |\n| --- | --- |\n| payerCode | Payer Code |\n| payerName | Payer Name |\n| isActive | Boolean determines if payer is active |\n| isSupportingEligibility | Boolean determines if payer is supporting eligibility |\n| isSupportingClaims | Boolean to see if payer is supporting claims |\n| isEDIPayer | Boolean to see if payer is EDI |"},"status":"Unauthorized","code":401,"_postman_previewlanguage":"json","header":[{"key":"Content-Type","value":"application/json"}],"cookie":[],"responseTime":null,"body":"{\n \"Message\": \"Access Token is Invalid with this User name or Client API id.\"\n}\n"}],"_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":"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.
\nGetPayerStatus Request
\nURL Parameter payerStatus value and description
\nGetPayerStatus Response
\n","urlObject":{"protocol":"https","path":["api","GetPayerStatus"],"host":["api","pverify","com"],"query":[],"variable":[]}},"response":[{"id":"9cc48604-92ec-4218-82ac-3045111bae88","name":"Success - Payer status","originalRequest":{"method":"GET","header":[{"key":"","value":"","disabled":true}],"url":"https://api.pverify.com/api/GetPayerStatus","description":"| Environment | URL |\n| --- | --- |\n| Production | [https://api.pverify.com/API/GetPayerStatus](https://api.pverify.com/API/GetPayerStatus) |\n\nThis 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.\n\n**GetPayerStatus Request**\n\n| Key | Value |\n| --- | --- |\n| URL | [http://api.pverify.com/api/GetPayerStatus](http://api.pverify.com/api/GetPayerStatus) |\n| Method | GET |\n| **URL Params** | Description |\n| GetPayerStatus | Allows you to return specific payer status from response |\n| **Headers** | None (this API call does not require authentication) |\n| **Body** | None |\n\n**URL Parameter payerStatus value and description**\n\n| Value | Description |\n| --- | --- |\n| Payer Up | Payer is Active and running transactions. |\n| Payer Active | Payer is Active but no recent transactions. |\n| Payer Inactive | This is marked as inactive in our system. |\n| Payer Down | Payer is Active but more transactions are failing from the past one hour. |\n\n**GetPayerStatus Response**\n\n| Key | Value |\n| --- | --- |\n| payerName | Name of payer |\n| payer_Code | Payer code |\n| payerStatus | Payer Status (see URL parameters description) |"},"status":"OK","code":200,"_postman_previewlanguage":"json","header":[{"key":"Content-Type","value":"application/json"}],"cookie":[],"responseTime":null,"body":"[\n {\n \"payerName\": \"Sample Payer One\",\n \"payer_Code\": \"00001\",\n \"payerStatus\": \"Payer Up\"\n },\n {\n \"payerName\": \"UHC\",\n \"payer_Code\": \"00192\",\n \"payerStatus\": \"Payer Active\"\n },\n {\n \"payerName\": \"Sample Payer Two\",\n \"payer_Code\": \"00045\",\n \"payerStatus\": \"Payer Down\"\n }\n]\n"},{"id":"88daeaea-d89c-40d5-8c96-d780b492b866","name":"Error - No payer statuses found","originalRequest":{"method":"GET","header":[{"key":"","value":"","disabled":true}],"url":"https://api.pverify.com/api/GetPayerStatus","description":"| Environment | URL |\n| --- | --- |\n| Production | [https://api.pverify.com/API/GetPayerStatus](https://api.pverify.com/API/GetPayerStatus) |\n\nThis 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.\n\n**GetPayerStatus Request**\n\n| Key | Value |\n| --- | --- |\n| URL | [http://api.pverify.com/api/GetPayerStatus](http://api.pverify.com/api/GetPayerStatus) |\n| Method | GET |\n| **URL Params** | Description |\n| GetPayerStatus | Allows you to return specific payer status from response |\n| **Headers** | None (this API call does not require authentication) |\n| **Body** | None |\n\n**URL Parameter payerStatus value and description**\n\n| Value | Description |\n| --- | --- |\n| Payer Up | Payer is Active and running transactions. |\n| Payer Active | Payer is Active but no recent transactions. |\n| Payer Inactive | This is marked as inactive in our system. |\n| Payer Down | Payer is Active but more transactions are failing from the past one hour. |\n\n**GetPayerStatus Response**\n\n| Key | Value |\n| --- | --- |\n| payerName | Name of payer |\n| payer_Code | Payer code |\n| payerStatus | Payer Status (see URL parameters description) |"},"status":"Not Found","code":404,"_postman_previewlanguage":"json","header":[{"key":"Content-Type","value":"application/json"}],"cookie":[],"responseTime":null,"body":"{\n \"Message\": \"No payer statuses are found\"\n}\n"}],"_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":[{"id":"f8edb13b-3011-4622-899a-9a4c1ba57090","name":"Success - Down payer statistics","originalRequest":{"method":"GET","header":[],"url":{"raw":"https://api.pverify.com/API/GetPayerStatusStatistics?status=Rejected&checkForLastNumberOfHours=1","protocol":"https","host":["api","pverify","com"],"path":["API","GetPayerStatusStatistics"],"query":[{"key":"status","value":"Rejected"},{"key":"checkForLastNumberOfHours","value":"1"}]},"description":"This API will return an array of payers that are known to be temporarily down."},"status":"OK","code":200,"_postman_previewlanguage":"json","header":[{"key":"Content-Type","value":"application/json"}],"cookie":[],"responseTime":null,"body":"[\n {\n \"payerID\": \"1045\",\n \"payer_Code\": \"00045\",\n \"payer_Name\": \"Sample Payer Two\",\n \"status\": \"Rejected\",\n \"transPercentage\": 87.5\n },\n {\n \"payerID\": \"1078\",\n \"payer_Code\": \"00078\",\n \"payer_Name\": \"Sample Payer Three\",\n \"status\": \"Rejected\",\n \"transPercentage\": 62.0\n }\n]\n"},{"id":"b7e4a043-8c26-4047-a355-8401b0544729","name":"Error - No payer statuses found","originalRequest":{"method":"GET","header":[],"url":{"raw":"https://api.pverify.com/API/GetPayerStatusStatistics?status=Rejected&checkForLastNumberOfHours=1","protocol":"https","host":["api","pverify","com"],"path":["API","GetPayerStatusStatistics"],"query":[{"key":"status","value":"Rejected"},{"key":"checkForLastNumberOfHours","value":"1"}]},"description":"This API will return an array of payers that are known to be temporarily down."},"status":"Not Found","code":404,"_postman_previewlanguage":"json","header":[{"key":"Content-Type","value":"application/json"}],"cookie":[],"responseTime":null,"body":"{\n \"Message\": \"No payer statuses are found\"\n}\n"}],"_postman_id":"9aca240b-585d-4eb9-a600-24dbda1a5b5a"}],"id":"950201fb-da4f-4724-a690-c4094270e294","description":"Before running an Eligibility Check request, it's often useful to know which payers pVerify supports and what state they're currently in. This section covers the three endpoints that let you look that information up directly, rather than discovering it only after a transaction fails or comes back delayed.
\nGetAllPayers — Returns pVerify's full list of supported payers, along with the payer identifiers you'll need to populate in your Eligibility and Insurance Discovery requests.
\nGetPayerStatus — Returns the current status of a specific payer connection, including whether that payer is handled in real time or through the Backoffice Workflow.
\nDownPayerList — Returns payers that are currently experiencing an outage or degraded connection, so you can proactively flag affected transactions rather than waiting on a failed or delayed response.
\nTo enable Back-Office Payers, you must contact pVerify support for setup. Most payers respond to eligibility requests in real time. Some payers, however, connect through non-electronic channels and can't return an immediate response — these are handled through our Backoffice Workflow, covered in the Eligibility section below. If you're integrating eligibility checks for the first time, we recommend reading that section before writing your retry/polling logic.
\nGetPayerStatus (and the payer records returned by GetAllPayers) tell you in advance whether a given payer will respond immediately (isEDIPayer) or requires the 24-hour Backoffice Workflow described in the Eligibility section. We strongly recommend checking this before submitting an EligibilityInquiry or EligibilitySummary request, so your integration can branch correctly — showing a real-time result to the user directly, or queuing the request and notifying the user that a response will take up to 24 hours — instead of discovering which path applies only after the request has already been submitted.
Call GetAllPayers periodically (e.g., nightly or on a schedule you control) to keep a local cache of supported payers, their identifiers, and their real-time/backoffice status — you generally don't need to call this before every transaction.
Check DownPayerList before submitting a batch of eligibility or discovery requests, so you can hold off on submissions to affected payers rather than have them fail or queue unnecessarily.
Use GetPayerStatus right before submitting a request to a specific payer if your integration branches logic based on real-time vs. backoffice handling — this is the recommended way to avoid surprises after submission.
pVerify Eligibility Summary is used to return objects with key data for your practice type. For example, when you send as practice type PT, we will return a Physical Therapy object with key PT benefits. To see the currently supported practice types please see the Practice Type table
\nHeaders
\n*Note: The Client-API-Id is required. Header keys are case sensitive.
\nGetEligibilitySummary 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.
\nHeaders
\n*Note: The Client-API-Id header is required. Header keys are case sensitive.
\nThis GET method will return EDI 271 Raw response with Eligibility Request ID as a parameter.
\nGetEligibility271 Request
\n*Note: The Client-API-Id header is required. Header keys are case sensitive.
\nGetEligibility271 Response
\nImportant: although the response is sent with a Content-Type: application/json header, the response body itself is not a JSON object. It is the raw EDI X12 271 ANSI text returned directly as the entire response body (or a plain error-message string on failure) — there is no EDI271ANSI wrapper key. Parse/display it as raw text, not as JSON.
This GET method returns the Eligibility Summary report as a PDF file for a previously completed EligibilitySummary transaction.
\nImportant: unlike most other pVerify API endpoints, this call is authenticated directly with your Client-API-Id and Client-Secret in the request headers - it does not use a Bearer access token from the Token endpoint.
\nEligibilityPDF Request
\nEligibilityPDF Request Details
\nEligibilityPDF Response
\nOn success (HTTP 200), the response body is the PDF file itself (Content-Type: application/pdf) - it is not JSON, so no JSON success example is shown here.
\nOn failure, the response is a small JSON object:
\n","urlObject":{"protocol":"https","path":["Report","EligibilityPDFReport","9882795"],"host":["premium","pverify","com"],"query":[],"variable":[]}},"response":[{"id":"ad1fae20-16f5-4b8c-9d71-dc0508513a90","name":"Error - Invalid request ID","originalRequest":{"method":"GET","header":[{"key":"Client-API-Id","value":"{{client-api-id}}"},{"key":"Client-Secret","value":"{{client-secret}}"},{"key":"Content-Type","value":"application/json"}],"url":"https://premium.pverify.com/Report/EligibilityPDFReport/9882795","description":"| Environment | URL |\n| --- | --- |\n| Test | [https://premiumtestaz.pverify.com/Report/EligibilityPDFReport/{elgRequestId}](https://premiumtestaz.pverify.com/Report/EligibilityPDFReport/%7BelgRequestId%7D) |\n| Production | [https://premium.pverify.com/Report/EligibilityPDFReport/{elgRequestId}](https://premium.pverify.com/Report/EligibilityPDFReport/%7BelgRequestId%7D) |\n\nThis GET method returns the Eligibility Summary report as a PDF file for a previously completed EligibilitySummary transaction.\n\n**Important:** unlike most other pVerify API endpoints, this call is authenticated directly with your Client-API-Id and Client-Secret in the request headers - it does not use a Bearer access token from the Token endpoint.\n\n**EligibilityPDF Request**\n\n| Key | Value |\n| --- | --- |\n| URL | [https://premium.pverify.com/Report/EligibilityPDFReport/{elgRequestId}](https://premium.pverify.com/Report/EligibilityPDFReport/%7BelgRequestId%7D) |\n| Method | GET |\n| **Headers** | **Description** |\n| Client-API-Id | Your pVerify Client-API-Id |\n| Client-Secret | Your pVerify Client-Secret |\n| Content-Type | application/json |\n\n**EligibilityPDF Request Details**\n\n| Property Name | Data Type | Usage | Description |\n| --- | --- | --- | --- |\n| elgRequestId (path parameter) | Integer | Required | The RequestID returned by a prior EligibilitySummary call |\n| isShort | Boolean | Optional | Query string. When true, generates the short-form summary report |\n| isSaleForce | Boolean | Optional | Query string. When true, failures are returned as plain HTTP error status codes instead of a JSON body |\n\n**EligibilityPDF Response**\n\nOn success (HTTP 200), the response body is the PDF file itself (Content-Type: application/pdf) - it is not JSON, so no JSON success example is shown here.\n\nOn failure, the response is a small JSON object:\n\n| Key | Type | Description |\n| --- | --- | --- |\n| Error | String | Description of why the PDF could not be generated (for example: missing headers, invalid request ID, invalid credentials, or an internal report-generation error) |\n"},"status":"OK","code":200,"_postman_previewlanguage":"json","header":[{"key":"Content-Type","value":"application/json"}],"cookie":[],"responseTime":null,"body":"{\n \"Error\": \"Invalid Request Id.\"\n}\n"}],"_postman_id":"51f0db87-8438-409a-936c-4e39a7dfd3da"},{"name":"GetEligibilityDetailsURL","id":"78d0dbe0-5c00-44d4-99ab-85837324ee0f","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/GetEligibilityDetailsURL/9882795","description":"This GET method generates a secure, time-limited URL (valid for 60 minutes) that can be used to view the full Eligibility Summary details for a given Eligibility transaction without requiring the user to log in to the pVerify Premium portal.
\nGetEligibilityDetailsURL Request
\n*Note: The Client-API-Id header is required. Header keys are case sensitive.
\nGetEligibilityDetailsURL Request Details
\nGetEligibilityDetailsURL Response Fields
\n","urlObject":{"protocol":"https","path":["API","GetEligibilityDetailsURL","9882795"],"host":["api","pverify","com"],"query":[],"variable":[]}},"response":[{"id":"b0be0f87-fc8b-42af-87a0-be332363a5a2","name":"Success - Details URL generated","originalRequest":{"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/GetEligibilityDetailsURL/9882795","description":"| Environment | URL |\n| --- | --- |\n| Test | [https://testapi.pverify.com/API/GetEligibilityDetailsURL/{requestId}](https://testapi.pverify.com/API/GetEligibilityDetailsURL/%7BrequestId%7D) |\n| Production | [https://api.pverify.com/API/GetEligibilityDetailsURL/{requestId}](https://api.pverify.com/API/GetEligibilityDetailsURL/%7BrequestId%7D) |\n\nThis GET method generates a secure, time-limited URL (valid for 60 minutes) that can be used to view the full Eligibility Summary details for a given Eligibility transaction without requiring the user to log in to the pVerify Premium portal.\n\n**GetEligibilityDetailsURL Request**\n\n| Key | Value |\n| --- | --- |\n| URL | [https://api.pverify.com/API/GetEligibilityDetailsURL/{requestId}](https://api.pverify.com/API/GetEligibilityDetailsURL/%7BrequestId%7D) |\n| Method | GET |\n| **Headers** | **Description** |\n| Authorization | Authorization token from above preceded by the String \"Bearer\" |\n| Client-API-Id | Your pVerify client-api-id |\n\n*Note: The Client-API-Id header is required. Header keys are case sensitive.\n\n**GetEligibilityDetailsURL Request Details**\n\n| Property Name | Data Type | Usage | Description |\n| --- | --- | --- | --- |\n| requestId (path parameter) | Integer | Required | The RequestID returned by a prior EligibilitySummary call |\n\n**GetEligibilityDetailsURL Response Fields**\n\n| Key | Type | Description |\n| --- | --- | --- |\n| isDetailsURLGenerated | Boolean | True when the details URL was generated successfully |\n| url | String | The generated time-limited details URL (valid for 60 minutes). Null when generation failed |\n| errorMessage | String | Description of the error, if any (for example: invalid request ID). Null on success |\n"},"status":"OK","code":200,"_postman_previewlanguage":"json","header":[{"key":"Content-Type","value":"application/json"}],"cookie":[],"responseTime":null,"body":"{\n \"isDetailsURLGenerated\": true,\n \"url\": \"https://premium.pverify.com/Details/Eligibility?uid=9F3D2A1B7C4E5F6082A1\",\n \"errorMessage\": null\n}\n"},{"id":"130d5992-6db2-45cf-86e3-0ade8d7ca43a","name":"Error - Invalid request ID","originalRequest":{"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/GetEligibilityDetailsURL/9882795","description":"| Environment | URL |\n| --- | --- |\n| Test | [https://testapi.pverify.com/API/GetEligibilityDetailsURL/{requestId}](https://testapi.pverify.com/API/GetEligibilityDetailsURL/%7BrequestId%7D) |\n| Production | [https://api.pverify.com/API/GetEligibilityDetailsURL/{requestId}](https://api.pverify.com/API/GetEligibilityDetailsURL/%7BrequestId%7D) |\n\nThis GET method generates a secure, time-limited URL (valid for 60 minutes) that can be used to view the full Eligibility Summary details for a given Eligibility transaction without requiring the user to log in to the pVerify Premium portal.\n\n**GetEligibilityDetailsURL Request**\n\n| Key | Value |\n| --- | --- |\n| URL | [https://api.pverify.com/API/GetEligibilityDetailsURL/{requestId}](https://api.pverify.com/API/GetEligibilityDetailsURL/%7BrequestId%7D) |\n| Method | GET |\n| **Headers** | **Description** |\n| Authorization | Authorization token from above preceded by the String \"Bearer\" |\n| Client-API-Id | Your pVerify client-api-id |\n\n*Note: The Client-API-Id header is required. Header keys are case sensitive.\n\n**GetEligibilityDetailsURL Request Details**\n\n| Property Name | Data Type | Usage | Description |\n| --- | --- | --- | --- |\n| requestId (path parameter) | Integer | Required | The RequestID returned by a prior EligibilitySummary call |\n\n**GetEligibilityDetailsURL Response Fields**\n\n| Key | Type | Description |\n| --- | --- | --- |\n| isDetailsURLGenerated | Boolean | True when the details URL was generated successfully |\n| url | String | The generated time-limited details URL (valid for 60 minutes). Null when generation failed |\n| errorMessage | String | Description of the error, if any (for example: invalid request ID). Null on success |\n"},"status":"OK","code":200,"_postman_previewlanguage":"json","header":[{"key":"Content-Type","value":"application/json"}],"cookie":[],"responseTime":null,"body":"{\n \"isDetailsURLGenerated\": false,\n \"url\": null,\n \"errorMessage\": \"Invalid Request ID.\"\n}\n"}],"_postman_id":"78d0dbe0-5c00-44d4-99ab-85837324ee0f"}],"id":"a009534c-4bff-434a-86a0-9065d24c7585","_postman_id":"a009534c-4bff-434a-86a0-9065d24c7585","description":""},{"name":"Non EDI Payers","item":[{"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":"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.
\nGetPendingInquiries Request
\n","urlObject":{"protocol":"https","path":["API","GetPendingInquiries"],"host":["api","pverify","com"],"query":[{"key":"DOS","value":"01-01-2018"}],"variable":[]}},"response":[{"id":"7371ea54-1001-4c5f-8a44-0f862ed7e299","name":"Success - Pending inquiries list","originalRequest":{"method":"GET","header":[{"key":"Authorization","value":"Bearer {{access-token}}"},{"key":"Client-API-Id","value":"{{client-api-id}}"},{"key":"Content-Type","value":"application/json"}],"url":{"raw":"https://api.pverify.com/API/GetPendingInquiries?DOS=01-01-2018","protocol":"https","host":["api","pverify","com"],"path":["API","GetPendingInquiries"],"query":[{"key":"DOS","value":"01-01-2018"}]},"description":"| Environment | URL |\n| --- | --- |\n| Production | [https://api.pverify.com/API/GetPendingInquiries?DOS=01-01-2018](https://api.pverify.com/API/GetPendingInquiries?DOS=01-01-2018) |\n\nThis 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.\n\n**GetPendingInquiries Request**\n\n| Key | Value |\n| --- | --- |\n| URL | [https://api.pverify.com/API/GetPendingInquiries?DOS=01-01-2018](https://api.pverify.com/API/GetPendingInquiries?DOS=01-01-2018) |\n| Method | GET |\n| **Headers** | Description |\n| Authorization | Authorization token from above preceded by the String \"Bearer\" |\n| Client-API-Id | Your pVerify client-api-id |\n| URL Parameters | Date of Service (format is MM-DD-YYYY) |"},"status":"OK","code":200,"_postman_previewlanguage":"json","header":[{"key":"Content-Type","value":"application/json"}],"cookie":[],"responseTime":null,"body":"[\n {\n \"transactionId\": 30455123,\n \"status\": \"Pending\",\n \"doS_StartDate\": \"2018-01-01T00:00:00\",\n \"memberId\": \"123sfadfaf\",\n \"patientFirstName\": \"fname\",\n \"patientLastName\": \"lname\",\n \"patientDOB\": \"1980-01-01T00:00:00\",\n \"isDependentVerification\": false\n },\n {\n \"transactionId\": 30455124,\n \"status\": \"Pending\",\n \"doS_StartDate\": \"2018-01-01T00:00:00\",\n \"memberId\": \"456adfghj\",\n \"patientFirstName\": \"depfname\",\n \"patientLastName\": \"deplname\",\n \"patientDOB\": \"2010-05-15T00:00:00\",\n \"isDependentVerification\": true\n }\n]\n"},{"id":"08472714-dfd2-4c33-9b8a-0f84a537ff58","name":"No pending inquiries found","originalRequest":{"method":"GET","header":[{"key":"Authorization","value":"Bearer {{access-token}}"},{"key":"Client-API-Id","value":"{{client-api-id}}"},{"key":"Content-Type","value":"application/json"}],"url":{"raw":"https://api.pverify.com/API/GetPendingInquiries?DOS=01-01-2018","protocol":"https","host":["api","pverify","com"],"path":["API","GetPendingInquiries"],"query":[{"key":"DOS","value":"01-01-2018"}]},"description":"| Environment | URL |\n| --- | --- |\n| Production | [https://api.pverify.com/API/GetPendingInquiries?DOS=01-01-2018](https://api.pverify.com/API/GetPendingInquiries?DOS=01-01-2018) |\n\nThis 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.\n\n**GetPendingInquiries Request**\n\n| Key | Value |\n| --- | --- |\n| URL | [https://api.pverify.com/API/GetPendingInquiries?DOS=01-01-2018](https://api.pverify.com/API/GetPendingInquiries?DOS=01-01-2018) |\n| Method | GET |\n| **Headers** | Description |\n| Authorization | Authorization token from above preceded by the String \"Bearer\" |\n| Client-API-Id | Your pVerify client-api-id |\n| URL Parameters | Date of Service (format is MM-DD-YYYY) |"},"status":"OK","code":200,"_postman_previewlanguage":"json","header":[{"key":"Content-Type","value":"application/json"}],"cookie":[],"responseTime":null,"body":"[]\n"}],"_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":"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.
\nCancelTransaction Request
\n*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":[{"id":"7435ff3d-945e-48a8-a36e-b48935e0bb4a","name":"Success - Transaction cancelled","originalRequest":{"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":"| Environment | URL |\n| --- | --- |\n| Production | [https://api.pverify.com/API/CancelTransaction](https://api.pverify.com/API/CancelTransaction) |\n\nThis 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.\n\n**CancelTransaction Request**\n\n| Key | Value |\n| --- | --- |\n| URL | [https://api.pverify.com/API/CancelTransaction](https://api.pverify.com/API/CancelTransaction) |\n| Method | POST |\n| **Headers** | Description |\n| Authorization | Authorization token from above preceded by the String \"Bearer\" |\n| Client-API-Id\\* | pVerify client-api-id |\n| Content-Type | application/json |\n| **Body** | Description |\n| transactionId | Transaction ID for transaction you wish to cancel |\n\n\\*Note: The Client-API-Id is required in header. Header keys are case sensitive."},"status":"OK","code":200,"_postman_previewlanguage":"json","header":[{"key":"Content-Type","value":"application/json"}],"cookie":[],"responseTime":null,"body":"{\n \"isCancelled\": true,\n \"currentStatus\": \"Cancelled\",\n \"message\": \"Transaction has been cancelled successfully.\"\n}\n"},{"id":"29446a8c-a066-4545-aeaf-26a762c3e28a","name":"Cancellation rejected - already processed","originalRequest":{"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":"| Environment | URL |\n| --- | --- |\n| Production | [https://api.pverify.com/API/CancelTransaction](https://api.pverify.com/API/CancelTransaction) |\n\nThis 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.\n\n**CancelTransaction Request**\n\n| Key | Value |\n| --- | --- |\n| URL | [https://api.pverify.com/API/CancelTransaction](https://api.pverify.com/API/CancelTransaction) |\n| Method | POST |\n| **Headers** | Description |\n| Authorization | Authorization token from above preceded by the String \"Bearer\" |\n| Client-API-Id\\* | pVerify client-api-id |\n| Content-Type | application/json |\n| **Body** | Description |\n| transactionId | Transaction ID for transaction you wish to cancel |\n\n\\*Note: The Client-API-Id is required in header. Header keys are case sensitive."},"status":"OK","code":200,"_postman_previewlanguage":"json","header":[{"key":"Content-Type","value":"application/json"}],"cookie":[],"responseTime":null,"body":"{\n \"isCancelled\": false,\n \"currentStatus\": \"Rejected\",\n \"message\": \"Rejected transaction can't be cancelled.\"\n}\n"}],"_postman_id":"6c6d5192-279f-4a19-ae56-7d05ce901c4b"}],"id":"283f09d7-7c33-4e90-950a-c93f92e4fb06","description":"Not every payer can respond to an eligibility check in real time. Some connect through non-electronic channels and require pVerify to submit the request to a queue, then retrieve the result later. This matters architecturally — a real-time call can safely block a UI while it waits; a Non EDI call cannot.
\nWorkflow:
\nGenerate a token.
\nCall EligibilitySummary (POST) to submit the request to the queue and receive a request ID.
Wait up to 24 hours.
\nCall GetEligibilitySummary using the request ID to retrieve the result.
Use GetPendingInquiries to see which submitted requests are still available/queued, and CancelTransaction to withdraw a request that's no longer needed.
Before you submit: check the payer's processing type using GetPayerStatus or GetAllPayers in the Payers section — this tells you in advance which workflow applies.
This workflow applies only to medical Eligibility. Dental Eligibility and Insurance Discovery are not affected — all dental payers and discovery checks are processed in real time.
\n","_postman_id":"283f09d7-7c33-4e90-950a-c93f92e4fb06"},{"name":"Dental Eligibility","item":[{"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\": \"firstname\",\r\n\t\t\"dob\": \"12/31/1967\",\r\n\t\t\"lastName\": \"lastname\",\r\n\t\t\"memberID\": \"123456789A\"\r\n\t},\r\n\t\"dependent\": null,\r\n\r\n\t\"isSubscriberPatient\": \"True\",\r\n\t\"doS_StartDate\": \"05/20/2026\",\r\n\t\"doS_EndDate\": \"05/20/2026\",\r\n\t\"PracticeTypeCode\": \"211\",\r\n\t\"referenceId\": \"MRN001\",\r\n\t\"Location\": \"TestLocation01\",\r\n \"dCodes\": [\r\n \"D0140\",\r\n \"D0150\",\r\n \"D0170\"\r\n ]\r\n\r\n}"},"url":"https://api.pverify.com/api/v2/DentalEligibilitySummary","description":"There two type of verifications Self and Dependent.
\nGetEligibilitySummary 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.
\nHeaders
\n*Note: The Client-API-Id header is required. Header keys are case sensitive.
\nV2 DentalEligibilitySummary verifies dental coverage and benefits, supporting both self and dependent inquiries, plus optional D-code–level benefit detail (coinsurance and deductible values per procedure code).
Request essentials:
\nPayerCode (pVerify or client-mapped payer code), Provider.LastName, Provider.NPI, Provider.TaxId, and Subscriber.MemberId are required for every request.
Set isSubscriberPatient to true for a self-inquiry or false for a dependent inquiry — when false, populate the Dependent object with the dependent's name and DOB.
Include DCodes to receive per-code benefit detail (DCodeBenefitsSummary, DCodesDetails) alongside the standard practice-type summaries (Dental Care, Diagnostic, Orthodontic, Periodontic, Prosthodontic, Restorative, and others).
Response and error handling use the same shape as standard Eligibility — ProcessedWithError, ErrorCode, ErrorDescription, and IsSkipped behave identically. See Eligibility → Error Handling above.
No dental payers use the Non EDI workflow — all dental eligibility checks are processed in real time. The Non EDI Payers workflow described below applies only to medical Eligibility.
\n","_postman_id":"113545f6-b404-4a1e-a4c8-0099ba361bfe"}],"id":"f616b939-f39a-41dc-92c8-cdcc96da2d06","description":"This section covers verifying a patient's active coverage, benefits, and copays with a known payer — for medical/vision (Eligibility) and dental (Dental Eligibility) transactions — along with how to handle payers that can't respond in real time (Non EDI Payers). If you don't yet know the patient's payer or member ID, see Insurance Discovery instead.
\nEligibilitySummary is the recommended way to run a medical eligibility check — it works across the large majority of payers and returns structured, discrete objects (Medicare info, payer change, service-type copays).
To enable Back-Office Payers, you must contact pVerify support for setup. Most payers respond immediately. Some connect through non-electronic channels and can't return a real-time response — these are covered separately in Non EDI Payers below. Before submitting, check the payer's processing type using GetPayerStatus or GetAllPayers in the Payers section, so your integration can branch correctly instead of discovering which workflow applies after submission.
For EligibilitySummary calls, pVerify can return Medicare preventive service information. Either populate the HCPCSCodes array in the request, or configure preventive service codes once in the portal (Premium.Pverify.com → Admin/Profile → Settings → Medicare HCPCS Codes) — those settings apply automatically whenever the request's HCPCS codes field is left blank.
EligibilitySummary responses also include a MedicareInfoSummary object (Part A/B deductible remaining, pharmacy payer details, SNF/home health dates) and an OtherPayerInfo object (TPAs, workers' comp, plan sponsors).
pVerify will automatically perform a eligibility check (using Eligibility Summary) on selected MCA payers that allow lookup by MBI or Name & DOB, the result is returned in a field RecursiveRequestId.
\nThus the workflow is this:
\nSubmit eligibility call to Medicare via Eligibility Summary.
\nCapture RecursiveRequestId.
\nRun a GET call (GetEligibilitySummary) using this Id.
\npVerify will automatically perform a eligibility check (using Eligibility Summary) on selected Plan sponsor payers that are associated with Medicaid coverage. The result is returned in a field RecursiveRequestId.
\nThus the workflow is this:
\nSubmit eligibility call to Medicaid via Eligibility Summary.
\nCapture RecursiveRequestId.
\nRun a GET call (GetEligibilitySummary) using this Id.
\nGetEligibility271 returns the raw X12 271 response for a given request, rather than pVerify's structured JSON summary. Use this if you need the original EDI transaction itself — for example, to feed into a downstream system that expects raw X12, or to troubleshoot a discrepancy against what EligibilitySummary reports. Most integrations won't need this and can rely on the structured response instead.
Dependents don't require a separate call or request structure — run them through the regular EligibilitySummary request. If the dependent has active eligibility, the response will indicate it either way, so there's no special handling needed to check for dependent coverage specifically.
A transaction that completes but encounters an issue is reported within the response body rather than as an HTTP-level error:
\nProcessedWithError — indicates whether the transaction was processed with an error
ErrorCode / ErrorDescription — the specific error code and description for the transaction
FollowUpAction / PossibleResolution — recommended next steps based on the payer's response
EDIErrorMessage — the raw error message returned by the payer, when available
Duplicate submissions are handled automatically: if the same transaction is verified more than once, pVerify skips reprocessing and returns the last successful response, indicated by IsSkipped: true. Retrying an identical request is safe and won't create a duplicate transaction. Contact support to setup skip functionality.
Use the test environment (https://testapi.pverify.com) to build and validate your integration before pointing requests at production. Test environment responses don't contain any PHI — they return representative data so you can build and demo safely without a BAA or real patient information in place.
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.
Headers
\n*Note: The Client-API-Id is required. Header keys are case sensitive.
\nGetInusuranceDiscoverySummaryResponse returns the response from the InsuranceDiscovery POST call using a unique request id provided in the InsuranceDiscovery response.
\nHeaders
\n*Note: The Client-API-Id header is required. Header keys are case sensitive.
\nSee InsuranceDiscovery response.
\n","urlObject":{"protocol":"https","path":["api","GetInusuranceDiscoverySummaryResponse","467"],"host":["api","pverify","com"],"query":[],"variable":[]}},"response":[{"id":"5267dddb-dc72-412f-bdba-bf33c811ef4b","name":"Success - Specialist Consultation practice type","originalRequest":{"method":"GET","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":""},"url":"https://api.pverify.com/api/GetInusuranceDiscoverySummaryResponse/467","description":"| Environment | URL |\n| --- | --- |\n| Test | [https://testapi.pverify.com/API/GetInusuranceDiscoverySummaryResponse/{id}](https://testapi.pverify.com/API/GetInusuranceDiscoverySummaryResponse/%7Bid%7D) |\n| Production | [https://api.pverify.com/API/GetInusuranceDiscoverySummaryResponse/{id}](https://api.pverify.com/API/GetInusuranceDiscoverySummaryResponse/%7Bid%7D) |\n\nGetInusuranceDiscoverySummaryResponse returns the response from the InsuranceDiscovery POST call using a unique request id provided in the InsuranceDiscovery response.\n\n**Headers**\n\n| Key | Value |\n| --- | --- |\n| URL | [https://api.pverify.com/API/GetInusuranceDiscoverySummaryResponse/{id}](https://api.pverify.com/API/GetInusuranceDiscoverySummaryResponse/%7Bid%7D) |\n| Method | GET |\n| **Headers** | Description |\n| Authorization | Authorization token from above preceded by the String \"Bearer\" |\n| Client-API-Id\\* | Your pVerify client-api-id |\n| Client-API-Id | API ID provided by pVerify |\n| Content-Type | application/json |\n| URL Parameters | RequestId returned in InsuranceDiscovery response |\n\n\\*Note: The Client-API-Id header is required. Header keys are case sensitive.\n\n### GetInusuranceDiscoverySummaryResponse Response Fields\n\nSee [InsuranceDiscovery response](#insurancediscovery-response-fields)."},"status":"OK","code":200,"_postman_previewlanguage":"json","header":[{"key":"Content-Type","value":"application/json"}],"cookie":[],"responseTime":null,"body":"{\n \"RequestID\": 55219034,\n \"APIResponseCode\": \"0\",\n \"APIResponseMessage\": \"Processed\",\n \"EDIErrorMessage\": null,\n \"FollowUpAction\": null,\n \"PossibleResolution\": null,\n \"IsPayerBackOffice\": false,\n \"ProcessedWithError\": false,\n \"ErrorCode\": null,\n \"ErrorDescription\": null,\n \"PverifyPayerCode\": \"00192\",\n \"PayerName\": \"UHC\",\n \"ClientPayerName\": null,\n \"VerificationType\": \"Subscriber\",\n \"DOS\": \"04/28/2023-04/28/2023\",\n \"ExceptionNotes\": null,\n \"IsHMOPlan\": false,\n \"AddtionalInfo\": null,\n \"Location\": \"CA\",\n \"FallbackDisclaimer\": null,\n \"ReferrenceId\": null,\n \"InternalId\": null,\n \"CustomerId\": null,\n \"Notes\": \"\",\n \"ResultPracticeType\": \"Specialist Office\",\n \"AreAllSTCsProcessed\": true,\n \"STCsStatusMessage\": null,\n \"IsProviderInNetwork\": null,\n \"RecursiveType\": null,\n \"RecursiveRequestId\": 0,\n \"RecursiveAPIResponseCode\": null,\n \"RecursiveAPIResponseMessage\": null,\n \"RecursiveProcessedWithError\": false,\n \"IsSkipped\": false,\n \"DetailsURL\": null,\n \"IsPriorAuthRequired\": null,\n \"ProcessRealtime\": true,\n \"DemographicInfo\": {\n \"Subscriber\": {\n \"Address1\": null,\n \"Address2\": null,\n \"City\": null,\n \"CommunicationNumber\": null,\n \"Date\": null,\n \"DOB_R\": \"01/01/1950\",\n \"Firstname\": \"TEST\",\n \"Gender_R\": \"M\",\n \"Identification\": null,\n \"Lastname_R\": \"TEST\",\n \"Middlename\": null,\n \"State\": \"CA\",\n \"Suffix\": null,\n \"Zip\": null,\n \"MilitaryPersonnelInfo\": null\n },\n \"Dependent\": null\n },\n \"OtherPayerInfo\": null,\n \"IPADetails\": null,\n \"PlanCoverageSummary\": {\n \"Status\": \"Active\",\n \"EffectiveDate\": \"01/01/2023\",\n \"ExpiryDate\": null,\n \"PlanName\": \"UHC Choice Plus\",\n \"SelfFundedPlan\": \"No\",\n \"PolicyType\": \"PPO\",\n \"GroupNumber\": \"GRP98765\",\n \"GroupName\": \"Sample Employer Group\",\n \"PlanNetworkID\": null,\n \"PlanNetworkName\": \"Choice Plus Network\",\n \"SubscriberRelationship\": \"Self\",\n \"PlanNumber\": null,\n \"HRAorHSALimitationsRemaining\": null,\n \"LastUpdatedDateOfEDI\": \"04/28/2023\",\n \"PatientGender\": \"M\",\n \"BenefitPlanCode\": null,\n \"IssueDate\": null\n },\n \"PCPAuthInfoSummary\": null,\n \"HBPC_Deductible_OOP_Summary\": {\n \"IndividualDeductibleInNet\": { \"Value\": \"1000.00\", \"Notes\": null },\n \"IndividualDeductibleOutNet\": null,\n \"IndividualDeductibleRemainingInNet\": { \"Value\": \"750.00\", \"Notes\": null },\n \"IndividualDeductibleRemainingOutNet\": null,\n \"FamilyDeductibleInNet\": null,\n \"FamilyDeductibleOutNet\": null,\n \"FamilyDeductibleRemainingInNet\": null,\n \"FamilyDeductibleRemainingOutNet\": null,\n \"IndividualOOP_InNet\": { \"Value\": \"5000.00\", \"Notes\": null },\n \"IndividualOOP_OutNet\": null,\n \"IndividualOOPRemainingInNet\": { \"Value\": \"4200.00\", \"Notes\": null },\n \"IndividualOOPRemainingOutNet\": null,\n \"FamilyOOPInNet\": null,\n \"FamilyOOPOutNet\": null,\n \"FamilyOOPRemainingInNet\": null,\n \"FamilyOOPRemainingOutNet\": null\n },\n \"MedicareInfoSummary\": null,\n \"SpecialistOfficeSummary\": {\n \"IndividualDeductibleInNet\": { \"Value\": \"1000.00\", \"Notes\": null },\n \"IndividualDeductibleOutNet\": null,\n \"IndividualDeductibleRemainingInNet\": { \"Value\": \"750.00\", \"Notes\": null },\n \"IndividualDeductibleRemainingOutNet\": null,\n \"FamilyDeductibleInNet\": null,\n \"FamilyDeductibleOutNet\": null,\n \"FamilyDeductibleRemainingInNet\": null,\n \"FamilyDeductibleRemainingOutNet\": null,\n \"IndividualOOP_InNet\": { \"Value\": \"5000.00\", \"Notes\": null },\n \"IndividualOOP_OutNet\": null,\n \"IndividualOOPRemainingInNet\": { \"Value\": \"4200.00\", \"Notes\": null },\n \"IndividualOOPRemainingOutNet\": null,\n \"FamilyOOPInNet\": null,\n \"FamilyOOPOutNet\": null,\n \"FamilyOOPRemainingInNet\": null,\n \"FamilyOOPRemainingOutNet\": null,\n \"ServiceCoveredInNet\": \"Yes\",\n \"ServiceCoveredOutNet\": \"Yes\",\n \"CoPayInNet\": { \"Value\": \"40.00\", \"Notes\": null },\n \"CoInsInNet\": { \"Value\": \"20\", \"Notes\": \"Percent\" },\n \"CoPayOutNet\": null,\n \"CoInsOutNet\": { \"Value\": \"40\", \"Notes\": \"Percent\" },\n \"UMOName\": null,\n \"UMOTelephone\": null,\n \"InNetServiceAuthorizationInfo\": null,\n \"OutNetServiceAuthorizationInfo\": null\n },\n \"ComboPayerResponses\": [\n {\n \"Status\": \"NoStatus\",\n \"PayerName\": \"Medi-Cal\",\n \"ErrorMessage\": \"No active coverage found\",\n \"PayerCode\": \"BO00002\",\n \"PverifyPayerCode\": \"BO00002\",\n \"ClientPayerName\": null,\n \"TransactionStatus\": \"Processed\",\n \"PayerResponse\": null,\n \"TranId\": 0,\n \"RequestId\": 0,\n \"FullName\": \"TEST TEST\",\n \"DOB\": \"01/01/1950\",\n \"Address\": null,\n \"MemberID\": null,\n \"City\": null,\n \"State\": \"CA\",\n \"Zip\": null,\n \"PlanCoverageSummary\": null\n }\n ],\n \"PreventiveServices\": [],\n \"ServiceDetails\": [\n {\n \"ServiceName\": \"Health Benefit Plan Coverage\",\n \"EligibilityDetails\": [\n {\n \"AuthorizationOrCertificationRequired\": null,\n \"EligibilityOrBenefit\": \"Active Coverage\",\n \"CoverageLevel\": \"Individual\",\n \"Date\": null,\n \"Identifications\": null,\n \"InsuranceType\": \"PPO\",\n \"Message\": null,\n \"MonetaryAmount\": null,\n \"Percent\": null,\n \"PlanCoverageDescription\": \"Choice Plus\",\n \"PlanNetworkIndicator\": \"Yes\",\n \"QuantityQualifier\": null,\n \"Quantity\": null,\n \"TimePeriodQualifier\": null,\n \"Procedure\": null,\n \"PlaceOfService\": null,\n \"BenefitEntities\": null,\n \"HealthCareServiceDeliveries\": null\n }\n ]\n }\n ],\n \"DisclaimerMessage\": null,\n \"EligibilityResult\": null,\n \"NonEDIResultPath\": null,\n \"DentalInfo\": null,\n \"AppliedBusinessRuleIDs\": null,\n \"MBI\": null,\n \"FullName\": \"TEST TEST\",\n \"DOB\": \"01/01/1950\",\n \"Address\": null,\n \"MemberID\": null,\n \"City\": null,\n \"State\": \"CA\",\n \"Zip\": null,\n \"PayerFound\": true,\n \"MiscellaneousInfoSummary\": {\n \"RemainingSpendDown\": null,\n \"IsNPIInNetwork\": \"Yes\",\n \"MemberID\": null\n }\n}\n"},{"id":"af28c9ee-334e-42f4-b5c6-fd10bd2368cc","name":"Error - Invalid request ID","originalRequest":{"method":"GET","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":""},"url":"https://api.pverify.com/api/GetInusuranceDiscoverySummaryResponse/467","description":"| Environment | URL |\n| --- | --- |\n| Test | [https://testapi.pverify.com/API/GetInusuranceDiscoverySummaryResponse/{id}](https://testapi.pverify.com/API/GetInusuranceDiscoverySummaryResponse/%7Bid%7D) |\n| Production | [https://api.pverify.com/API/GetInusuranceDiscoverySummaryResponse/{id}](https://api.pverify.com/API/GetInusuranceDiscoverySummaryResponse/%7Bid%7D) |\n\nGetInusuranceDiscoverySummaryResponse returns the response from the InsuranceDiscovery POST call using a unique request id provided in the InsuranceDiscovery response.\n\n**Headers**\n\n| Key | Value |\n| --- | --- |\n| URL | [https://api.pverify.com/API/GetInusuranceDiscoverySummaryResponse/{id}](https://api.pverify.com/API/GetInusuranceDiscoverySummaryResponse/%7Bid%7D) |\n| Method | GET |\n| **Headers** | Description |\n| Authorization | Authorization token from above preceded by the String \"Bearer\" |\n| Client-API-Id\\* | Your pVerify client-api-id |\n| Client-API-Id | API ID provided by pVerify |\n| Content-Type | application/json |\n| URL Parameters | RequestId returned in InsuranceDiscovery response |\n\n\\*Note: The Client-API-Id header is required. Header keys are case sensitive.\n\n### GetInusuranceDiscoverySummaryResponse Response Fields\n\nSee [InsuranceDiscovery response](#insurancediscovery-response-fields)."},"status":"Bad Request","code":400,"_postman_previewlanguage":"json","header":[{"key":"Content-Type","value":"application/json"}],"cookie":[],"responseTime":null,"body":"{\n \"Message\": \"Invalid Request Id.Please send valid request Id\"\n}\n"}],"_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":"This GET method will return details URL with Insurance Discovery Request ID as a parameter.
\nGetInsuranceDiscoveryDetailsURL Request
\n*Note: The Client-API-Id header is required. Header keys are case sensitive.
\nGetInsuranceDiscoveryDetailsURL Resposne
\nJSON Response
\n{
\n\"isDetailsURLGenerated\": true,
\n\"url\": \"https://premium.pverify.com/Details\",
\n\"errorMessage\": null
\n}
\n","urlObject":{"protocol":"https","path":["API","GetInsuranceDiscoveryDetailsURL","{requestID}"],"host":["api","pverify","com"],"query":[],"variable":[]}},"response":[{"id":"0d12d8dc-1b0b-44b9-9a91-0773d8da3d6c","name":"Success - Details URL generated","originalRequest":{"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/GetInsuranceDiscoveryDetailsURL/{requestID}","description":"| Environment | URL |\n| --- | --- |\n| Test | /API/GetInsuranceDiscoveryDetailsURL/{id} |\n| Production | /API/GetInsuranceDiscoveryDetailsURL/{id} |\n\nThis GET method will return details URL with Insurance Discovery Request ID as a parameter.\n\n**GetInsuranceDiscoveryDetailsURL Request**\n\n| Key | Value |\n| --- | --- |\n| URL | /API/GetInsuranceDiscoveryDetailsURL/{id} |\n| Method | GET |\n| **Headers** | **Description** |\n| Authorization | Authorization token from above preceded by the String \"Bearer\" |\n| Client-API-Id\\* | Your pVerify client-api-id |\n| Content-Type | application/json |\n\n\\*Note: The Client-API-Id header is required. Header keys are case sensitive.\n\n**GetInsuranceDiscoveryDetailsURL Resposne**\n\n| **Key** | **Value** |\n| --- | --- |\n| isDetailsURLGenerated | True or false |\n| url | string URL |\n| errorMessage | Message when isDetailsURLGenerated is false |\n\n**JSON Response**\n\n{\n\n\"isDetailsURLGenerated\": true,\n\n\"url\": \"[https://premium.pverify.com/Details\"](https://premium.pverify.com/Details),\n\n\"errorMessage\": null\n\n}"},"status":"OK","code":200,"_postman_previewlanguage":"json","header":[{"key":"Content-Type","value":"application/json"}],"cookie":[],"responseTime":null,"body":"{\n \"isDetailsURLGenerated\": true,\n \"url\": \"https://premium.pverify.com/Details?id=9F3D2A1B7C4E5F6082A1\",\n \"errorMessage\": null\n}\n"},{"id":"b66cc811-d813-482b-b093-46ed785512b1","name":"Error - Invalid request ID","originalRequest":{"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/GetInsuranceDiscoveryDetailsURL/{requestID}","description":"| Environment | URL |\n| --- | --- |\n| Test | /API/GetInsuranceDiscoveryDetailsURL/{id} |\n| Production | /API/GetInsuranceDiscoveryDetailsURL/{id} |\n\nThis GET method will return details URL with Insurance Discovery Request ID as a parameter.\n\n**GetInsuranceDiscoveryDetailsURL Request**\n\n| Key | Value |\n| --- | --- |\n| URL | /API/GetInsuranceDiscoveryDetailsURL/{id} |\n| Method | GET |\n| **Headers** | **Description** |\n| Authorization | Authorization token from above preceded by the String \"Bearer\" |\n| Client-API-Id\\* | Your pVerify client-api-id |\n| Content-Type | application/json |\n\n\\*Note: The Client-API-Id header is required. Header keys are case sensitive.\n\n**GetInsuranceDiscoveryDetailsURL Resposne**\n\n| **Key** | **Value** |\n| --- | --- |\n| isDetailsURLGenerated | True or false |\n| url | string URL |\n| errorMessage | Message when isDetailsURLGenerated is false |\n\n**JSON Response**\n\n{\n\n\"isDetailsURLGenerated\": true,\n\n\"url\": \"[https://premium.pverify.com/Details\"](https://premium.pverify.com/Details),\n\n\"errorMessage\": null\n\n}"},"status":"OK","code":200,"_postman_previewlanguage":"json","header":[{"key":"Content-Type","value":"application/json"}],"cookie":[],"responseTime":null,"body":"{\n \"isDetailsURLGenerated\": false,\n \"url\": null,\n \"errorMessage\": \"Invalid Request ID.\"\n}\n"}],"_postman_id":"75555e77-f971-475a-9e83-868b8601ffdc"}],"id":"09aaf422-3c18-4193-90d4-c7ae5b78b423","description":"Insurance Discovery lets Hospitals and Providers find a patient's active insurance coverage using demographic information — helpful when a patient can't provide a payer, member ID, or insurance card. Use it to recover coverage on accounts that would otherwise go to self-pay, and to reduce denials tied to missing or outdated coverage information.
\nInsurance Discovery includes MBI Lookup as part of its process. If you already know or strongly suspect a patient is Medicare-eligible and don't need the broader coverage search, calling MBI Lookup directly is the cheaper option.
\nInsurance Discovery is submitted and retrieved in two steps, similar to MBI Lookup — though in practice, results are typically available within a few seconds:
\nGenerate a token.
\nCall InsuranceDiscovery (POST) to submit the request and receive a RequestID.
Call GetInusuranceDiscoverySummaryResponse/{id} (GET) using that RequestID to retrieve the result.
Optionally, call GetInsuranceDiscoveryDetailsURL/{id} using the same RequestID to get a link, useful for sharing, printing, or archiving a discovery check outside the API response itself. The response reports whether the link was successfully generated (isDetailsURLGenerated), the url itself, and an errorMessage if generation failed.
patientState accepts a standard two-letter U.S. state abbreviation (e.g., CA, MD) for the patient's state of residence. No separate setup or lookup with pVerify is required.
Note that this is distinct from location, which is the practice location (see below).
Required fields:
\npatientFirstName, patientLastName
patientDOB (format MM/dd/YYYY) — required for a self-inquiry, for better matching
doS_StartDate, doS_EndDate — the date-of-service window to check coverage against
location — the practice location; this scopes portal visibility, so users without access to a location won't see patients tied to it
patientState — standard two-letter state abbreviation for the patient's state of residence
Conditional fields:
\npatientSSN — used to power MBI lookup as part of the discovery process
patientGender — required for Medicaid patients
providerLastName — used along with providerNPI to override using Combo Payer Group Provider Last Name and NPI based on the supplied patientState.
providerNPI — used along with providerLastName to override using Combo Payer Group Provider Last Name and NPI based on the supplied patientState.
Optional fields that affect Medicare handling:
\nverifyMedicare (boolean, default false) — triggers a Medicare check automatically when the patient is over 30
patientHasDisability (boolean, default false) — forces a Medicare check regardless of age
Multiple matches: When ComboPayerResponses contains more than one entry, compare the returned demographic fields against your original request before treating any single entry as confirmed coverage — pVerify returns candidates, not a single guaranteed match.
MBI Skip Mechanism:
\nA 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
\nThis call is used to get the transaction result later using unique request id which is returned in MBIInquiry API call.
\nSample Response
\n{ \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\nMBI Lookup finds a patient's Medicare Beneficiary Identifier (MBI) when a patient is likely Medicare-eligible but can't provide their card or current MBI. It's a narrower, more targeted call than a full Insurance Discovery check: Insurance Discovery includes MBI lookup as part of its process, but running MBI Lookup on its own is a good choice when you already suspect a patient is on Medicare and just need the identifier to run a standard eligibility check against.
\nLike Insurance Discovery, MBI Lookup is asynchronous — you submit a request, then retrieve the result with a second call. Response time is typically near-instant and faster than Insurance Discovery.
\nGenerate a token.
\nCall MBIInquiry (POST) to submit the request and receive a RequestId.
Call GetMBIResponse/{requestId} (GET) to retrieve the result.
Required fields:
\nPatientSSN_or_HICN
PatientFirstName, PatientLastName, PatientDOB (format MM/dd/YYYY)
ProviderLastName, ProviderNPI (10 digits)
Optional fields:
\nMRN — your internal medical record number, up to 50 characters
Address.AddressLine1, Address.City, Address.State, Address.ZipCode — providing these may improve match confidence (see score in the response, below)
GetMBIResponse returns:
The score field is worth calling out prominently — it's the clearest match-confidence signal available in pVerify's API, and integrators should generally treat lower scores with more scrutiny before treating an MBI as confirmed.
Insurance Discovery includes MBI Lookup as part of its process — when verifyMedicare or patientHasDisability is set on an Insurance Discovery request, the same underlying MBI matching runs as part of that check. Calling MBI Lookup directly is the cheaper option when you already know or strongly suspect the patient is Medicare-eligible and don't need the broader coverage search Insurance Discovery performs.
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
\n*Note: The Client-API-Id is required. Header keys are case sensitive.
\nDescription:
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
\n*Note: The Client-API-Id is required. Header keys are case sensitive.
\nReturns a list of all matched patients. All other response fields are the same as the PatientFinderInquiry endpoint.
\n","urlObject":{"protocol":"https","path":["API","PatientFinderInquiryResults"],"host":["api","pverify","com"],"query":[],"variable":[]}},"response":[{"id":"a030723e-244b-4196-9156-fbee88d59ea9","name":"Success - Patient finder results","originalRequest":{"auth":{"type":"noauth"},"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\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":"| Environment | URL |\n| --- | --- |\n| Test | [https://testapi.pverify.com/API/PatientFinderInquiryResults](https://testapi.pverify.com/API/PatientFinderInquiryResults) |\n| Production | [https://api.pverify.com/API/PatientFinderInquiryResults](https://api.pverify.com/API/PatientFinderInquiryResults) |\n\n**Description:** \nReturns all matching patient records based on the search criteria. This endpoint is intended for workflows that require presenting multiple potential matches for verification.\n\n**Use Cases:** \nUsed in Patient Validator-Verification.\n\n**Behavior:** \nReturns all matched patient records that meet the criteria.\n\n**Headers**\n\n| Key | Value |\n| --- | --- |\n| URL | [https://api.pverify.com/API/PatientFinderInquiryResults](https://api.pverify.com/API/PatientFinderInquiryResults) |\n| Method | POST |\n| **Headers** | Description |\n| Authorization | Authorization token from above preceded by the String \"Bearer\" |\n| Client-API-Id | API ID provided by pVerify |\n| Content-Type | application/json |\n\n\\*Note: The Client-API-Id is required. Header keys are case sensitive.\n\n## PatientFinderInquiryResults Request Fields\n\n| Property Name | Data Type | Usage | Description |\n| --- | --- | --- | --- |\n| FirstName | String | Optional | First Name of patient forThis GET method will return complete response of PatientFinderInquiry endpoint. This call allows you to get the patient demographicverification result by a unique transaction ID.
\nGetPatientFinderResponse Request
\n*Note: The Client-API-Id header is required. Header keys are case sensitive.
\nA 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":[{"id":"4e7d6c77-8310-402c-b2af-bcd304263c53","name":"Success - Patient finder response","originalRequest":{"method":"GET","header":[{"key":"Authorization","value":"Bear {{access-token}}"},{"key":"Client-API-Id","value":"{{client-api-id}}"},{"key":"Content-Type","value":"application/json"}],"url":"https://api.pverify.com/API/GetPatientFinderResponse/0","description":"| Environment | URL |\n| --- | --- |\n| Test | [https://testapi.pverify.com/Test/API/GetPatientFinderResponse/{id}](https://testapi.pverify.com/API/GetPatientFinderResponse/0) |\n| Production | [https://api.pverify.com/API/GetPatientFinderResponse/{id}](https://api.pverify.com/Test/API/GetPatientFinderResponse/0) |\n\nThis GET method will return complete response of PatientFinderInquiry endpoint. This call allows you to get the patient demographicverification result by a unique transaction ID.\n\n**GetPatientFinderResponse Request**\n\n| Key | Value |\n| --- | --- |\n| URL | [https://api.pverify.com/API/GetEligibilityResponse/{id}](https://api.pverify.com/API/GetPatientFinderResponse/%7Bid%7D) |\n| Method | GET |\n| **Headers** | **Description** |\n| Authorization | Authorization token from above preceded by the String \"Bearer\" |\n| Client-API-Id\\* | Your pVerify client-api-id |\n\n\\*Note: The Client-API-Id header is required. Header keys are case sensitive.\n\nA successful GetPatientFinderResponse call will have the same format as the Patient Finder Inquiry response (above)."},"status":"OK","code":200,"_postman_previewlanguage":"json","header":[{"key":"Content-Type","value":"application/json"}],"cookie":[],"responseTime":null,"body":"{\n \"APIResponseCode\": 0,\n \"APIResponseMessage\": \"Processed\",\n \"RequestId\": 738294,\n \"Error\": null,\n \"Status\": \"Processed\",\n \"patientsFound\": 1,\n \"RequestHasSSN\": false,\n \"IsMBIRegistered\": true,\n \"IsTRHasError\": false,\n \"RequestGroupId\": \"GRP-9F3D2A1B\",\n \"Patients\": [\n {\n \"FirstName\": \"John\",\n \"LastName\": \"Doe\",\n \"MiddleName\": null,\n \"DOB\": \"05/12/1975\",\n \"SSN\": \"XXXXX6789\",\n \"RecordCount\": 1,\n \"Score\": 96,\n \"Emails\": null,\n \"Address\": {\n \"AddressLine1\": \"123 Main St\",\n \"AddressLine2\": null,\n \"City\": \"Sample City\",\n \"State\": \"NY\",\n \"ZipCode\": \"10001\",\n \"ReportedDate\": \"01/15/2020\"\n },\n \"PhoneNumber\": null,\n \"GroupId\": \"GRP-9F3D2A1B\",\n \"Aliases\": null\n }\n ],\n \"IsShowSSN\": true\n}\n"},{"id":"e15efb85-3895-4ddc-9a98-914cba967870","name":"Error - Invalid request ID","originalRequest":{"method":"GET","header":[{"key":"Authorization","value":"Bear {{access-token}}"},{"key":"Client-API-Id","value":"{{client-api-id}}"},{"key":"Content-Type","value":"application/json"}],"url":"https://api.pverify.com/API/GetPatientFinderResponse/0","description":"| Environment | URL |\n| --- | --- |\n| Test | [https://testapi.pverify.com/Test/API/GetPatientFinderResponse/{id}](https://testapi.pverify.com/API/GetPatientFinderResponse/0) |\n| Production | [https://api.pverify.com/API/GetPatientFinderResponse/{id}](https://api.pverify.com/Test/API/GetPatientFinderResponse/0) |\n\nThis GET method will return complete response of PatientFinderInquiry endpoint. This call allows you to get the patient demographicverification result by a unique transaction ID.\n\n**GetPatientFinderResponse Request**\n\n| Key | Value |\n| --- | --- |\n| URL | [https://api.pverify.com/API/GetEligibilityResponse/{id}](https://api.pverify.com/API/GetPatientFinderResponse/%7Bid%7D) |\n| Method | GET |\n| **Headers** | **Description** |\n| Authorization | Authorization token from above preceded by the String \"Bearer\" |\n| Client-API-Id\\* | Your pVerify client-api-id |\n\n\\*Note: The Client-API-Id header is required. Header keys are case sensitive.\n\nA successful GetPatientFinderResponse call will have the same format as the Patient Finder Inquiry response (above)."},"status":"Not Found","code":404,"_postman_previewlanguage":"json","header":[{"key":"Content-Type","value":"application/json"}],"cookie":[],"responseTime":null,"body":"{\n \"Message\": \"Invalid request Id\"\n}\n"}],"_postman_id":"674339a2-8b66-444a-b461-53d49660afe0"}],"id":"477ee60e-7ee6-4885-b41a-ace7b7a3aa29","description":"Patient Demographic Validator finds and verifies patient records using whatever demographic information you have on hand — name, DOB, address, or SSN — rather than requiring a specific payer or member ID. It's useful for confirming you have the right patient on file before running an eligibility check, or for reconciling incomplete patient records.
\nThere are two ways to search, depending on whether you need a single best match or a full list of candidates:
\nBoth are asynchronous: submit the request, then retrieve the result with GetPatientFinderResponse.
(Same test/production pattern applies to PatientFinderInquiryResults and GetPatientFinderResponse.)
Generate a token.
\nCall PatientFinderInquiry (single top match) or PatientFinderInquiryResults (all matches) with whatever demographic fields you have.
Call GetPatientFinderResponse/{id} using the returned RequestID to retrieve the result.
Only LastName is strictly required — everything else is optional — but a match needs at least one of these field combinations to run:
First Name, Last Name, Street Address, City, State
\nFirst Name, Last Name, DOB, City, State
\nFirst Name, Last Name, DOB, State
\nLast Name, DOB, Street Address, Zip Code
\nFirst Name, Last Name, Last 4 of SSN
\nFirst Name, Last Name, Full SSN
\nFirst Name, Last Name, Zip Code
\nFirst Name, Last Name, State
\nNote that Patients is always returned as an array in both endpoints — for PatientFinderInquiry it will contain exactly one entry (the best match); for PatientFinderInquiryResults it contains every match found.
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.
\nNote: this endpoint returns HTTP 200 for rejected requests too - always check apiResponseCode (0 = Processed, 1 = Rejected), not the HTTP status.
*Note: The Client-API-Id is required in header. Header keys are case sensitive.
\nNote: InternalId is accepted on the request but is not echoed back in this endpoint's response (unlike v2/Estimate, which does echo it back).
+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.
Runs an estimate for one or more practice-type services against a previously processed Eligibility Summary transaction (or as a Self Pay estimate, with no eligibility lookup required). Returns estimated patient responsibility per CPT code, broken out by practice type / service.
\nWorkflow: 1) Get a token via Token. 2) Call v2/Estimate, passing the token, the eligibilityRequestID from a prior Eligibility Summary call, and the CPT details to estimate. The same access token can be reused across subsequent calls.
Note: this endpoint returns HTTP 200 for error cases too - always check apiResponseCode (0 = Processed, 1 = Rejected).
Note: the EstimationPDF endpoint (below) is keyed by this same eligibilityRequestID, not by estimations[].estimationRequestId.
Returns the Patient Responsibility Estimate PDF for a v2/Estimate result, keyed by the same eligibilityRequestID that was passed to v2/Estimate. Uses Client-API-Id and Client-Secret directly in the request headers - it does not use a Bearer access token from the Token endpoint.
EstimationPDF Request
\nEstimationPDF Response
\nOn success (HTTP 200), the response body is the PDF file itself (Content-Type: application/pdf) - it is not JSON, so no JSON success example is shown here.
\n","urlObject":{"protocol":"https","path":["PDFReport","EstimationPDF","1000"],"host":["premium","pverify","com"],"query":[],"variable":[]}},"response":[{"id":"0cb8ba21-b500-442a-875e-d9dd2426a856","name":"Error - Invalid Request ID","originalRequest":{"method":"GET","header":[{"key":"Client-API-Id","value":"{{client-api-id}}"},{"key":"Client-Secret","value":"{{client-secret}}"},{"key":"Content-Type","value":"application/json"}],"url":"https://premium.pverify.com/PDFReport/EstimationPDF/0"},"status":"OK","code":200,"_postman_previewlanguage":"json","header":[{"key":"Content-Type","value":"application/json"}],"cookie":[],"responseTime":null,"body":"{\n \"Error\": \"Invalid Request Id.\"\n}"}],"_postman_id":"5e408c20-222a-4fc2-8bda-6c255e33a410"}],"id":"e299c681-6132-4c00-ad79-a571628ae521","description":"Unlike pVerify's other endpoints, this is a calculator, not a payer lookup — it estimates patient responsibility for a set of CPT codes using the CMS Medicare non-facility price index, combined with the patient's known benefit details (copay, coinsurance, deductible remaining).
\nThe estimator service must be enabled on your account
\nNo test environment is available for this endpoint — it's production-only. Budget for that when planning your integration and testing approach.
\nKey fields:
\nzipCode — use 0 for national pricing instead of a location-specific estimate
cptCodes — array of CPT codes; append a modifier with a dash (e.g., 93024-TC for the technical component of a cardiac drug stress test)
coPay, coinsPercentage, deductibleRemaining — the patient's known benefit values, used to calculate their share
outofPocketRemaining — leave blank to exclude it from the calculation entirely
isSecondaryStatusActive — if true, patient responsibility is calculated as zero (secondary insurance covers it)
NonMedicareMultipleFactor — a multiplier applied to the Medicare-based CPT values, for adjusting the estimate to non-Medicare pricing
Returns a broken-down estimate: patientResponsibility, copay, coInsAmount, estimatedAllowable, deductibleRemaining, outOfPocketRemaining, and amountPayable.
Deductible remaining must be met before insurance applies — if $1,000 remains and the procedure costs more than that, the patient owes the full $1,000 for that procedure.
\nOut-of-pocket remaining is typically a high number, intended for catastrophic coverage scenarios (major surgery, chemotherapy) — once it hits zero, patient responsibility becomes zero.
\nThe 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).
\n*Note: The Client-API-Id header is required. Header keys are case sensitive.
\nNote: The ClaimStatusInquiry for dependents is the same for self. However, it uses different data parameters.
\nThe API Response Codes and there description are shown below.
\n","urlObject":{"protocol":"https","path":["API","ClaimStatusInquiry"],"host":["api","pverify","com"],"query":[],"variable":[]}},"response":[{"id":"14784a88-1536-4300-9861-41514e77b904","name":"Success - Claim status found","originalRequest":{"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 \"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":"| Environment | URL |\n| --- | --- |\n| Test | [https://testapi.pverify.com/API/ClaimStatusInquiry](https://testapi.pverify.com/API/ClaimStatusInquiry) |\n| Production | [https://api.pverify.com/API/ClaimStatusInquiry](https://api.pverify.com/API/ClaimStatusInquiry) |\n\nThe 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).\n\n| Field | Description |\n| --- | --- |\n| URL | [https://api.pverify.com/API/ClaimStatusInquiry](https://api.pverify.com/API/ClaimStatusInquiry) |\n| Method | POST |\n| **Headers** | **Description** |\n| Content-Type | application/json |\n| Authorization | Bearer XXX |\n| Client-API-Id\\* | client-api-id provided by pVerify |\n| **Body** | See right |\n\n\\*Note: The Client-API-Id header is required. Header keys are case sensitive.\n\nNote: The ClaimStatusInquiry for dependents is the same for self. However, it uses different data parameters.\n\n## ClaimStatusInquiry Request Fields for Self\n\n| Property Name | Data Type | Usage | Description |\n| --- | --- | --- | --- |\n| payerCode | String | Required | pVerify payer Code (i.e. Aetna 00001) |\n| ProviderLastName | String | Optional | Provider Last Name |\n| ProviderNPI | String | Conditional | 10-digit NPI value (Not required when ProviderFederalTaxId is available) |\n| ProviderFederalTaxId | String | Conditional | 9 - digit Federal Tax Id (EIN) (not required when NPI is available) |\n| payerClaimNumber | String | Conditional | Payer claim number |\n| chargeAmount | String | Required | Charge Amount |\n| serviceStartDate | String | Required | Start date of service (Expected format: MM/dd/YYYY ie 01/01/2000) |\n| serviceEndDate | String | Required | End date of service (Expected format: MM/dd/YYYY ie 01/01/2000) |\n| subscriber | Object | Required | Subscriber demographic information |\n| subscriber.FirstName | String | Conditional | Subscriber first name |\n| subscriber.lastName | String | Conditional | Subscriber last name |\n| subscriber.dob | String | Conditional | Subscriber Date of Birth (Expected format: MM/dd/YYYY ie 01/01/2000) |\n| subscriber.memberID | String | Conditional | Member ID of subscriber |\n| subscriber.gender | String | Conditional | Gender of subscriber. Allowed M, F or O |\n| isPatientDependent | boolean | Optional | Determines if the patient is dependent |\n\n## ClaimStatusInquiry Request Fields for Dependents\n\n| Property Name | Data Type | Required | Description |\n| --- | --- | --- | --- |\n| payerCode | String | Yes | pVerify payer Code (i.e. Aetna 00001) |\n| ProviderLastName | String | No | Provider Last Name |\n| ProviderNPI | String | Conditional | 10-digit NPI value (Not required when ProviderFederalTaxId is available) |\n| ProviderFederalTaxId | String | Conditional | 9 - digit Federal Tax Id (EIN) (not required when NPI is available) |\n| payerClaimNumber | String | Conditional | Payer claim number |\n| chargeAmount | String | Yes | Charge Amount |\n| serviceStartDate | String | Yes | Start date of service (Expected format: MM/dd/YYYY ie 01/01/2000) |\n| serviceEndDate | String | Yes | End date of service (Expected format: MM/dd/YYYY ie 01/01/2000) |\n| subscriber | Object | Yes | Subscriber demographic information |\n| subscriber.FirstName | String | Conditional | Subscriber first name |\n| subscriber.lastName | String | Conditional | Subscriber last name |\n| subscriber.dob | String | Conditional | Subscriber Date of Birth (Expected format: MM/dd/YYYY ie 01/01/2000) |\n| subscriber.memberID | String | Conditional | Member ID of subscriber |\n| subscriber.gender | String | Conditional | Gender of subscriber.Allowed M, F or O |\n| isPatientDependent | boolean | No | Determines if the patient is dependent |\n| dependent | Object | Conditional | Dependent demographic information |\n| dependent.FirstName | String | Conditional | Dependent first name |\n| dependent.lastName | String | Conditional | Dependent last name |\n| dependent.dob | String | No | Dependent Date of Birth (Expected format: MM/dd/YYYY ie 01/01/2000) |\n| dependent.gender | String | Conditional | Gender of Dependent.Allowed M, F or O |\n\n## ClaimStatusInquiry Response Fields\n\n| Property Name | Data Type | Description |\n| --- | --- | --- |\n| RequestID | Long | Claim Status Request ID |\n| apiResponseCode | int | API transaction response code. Please see apiResponseCode table |\n| apiResponseMessage | String | API transaction response message |\n| ProcessedWithError | String | true when processed with error by the payer. |\n| payerClaimNo | String | Payer Claim Number (if returned in EDI 277) |\n| categoryCode | String | Category code of claim status |\n| category | String | Category of claim status |\n| claimStatusReasonCode | String | Claim Status Code |\n| claimStatus | String | Claim status text |\n| payer | Payer | Contains payer info |\n| providerInfo | Info | Contains provider info |\n| subscriber | Info | Contains Subscriber info |\n| dependent | Info | Contains dependent info |\n| ClaimStatuses | List | Contains Claim Status Info |\n| ClaimStatuses.serviceLine | List | Contains Claim Service line item info, ie: Code specific info |\n\nThe API Response Codes and there description are shown below.\n\n| APIResponseCode | Description |\n| --- | --- |\n| 0 | Processed |\n| 1 | Rejected |\n| 2 | NoFunds (insufficient account balance) |\n| 3 | InvalidRequest (Required data missing) |\n| 4 | InvalidFormat (data format or data fields are wrong) |\n| 5 | InvalidPayer (Payer does not support Claim Status electronically / inactive) |\n| 6 | LocationError (Location is not configured) |"},"status":"OK","code":200,"_postman_previewlanguage":"json","header":[{"key":"Content-Type","value":"application/json"}],"cookie":[],"responseTime":null,"body":"{\n \"apiResponseCode\": 0,\n \"apiResponseMessage\": \"Processed\",\n \"requestId\": 88213345,\n \"processedWithError\": false,\n \"payerClaimNo\": \"CLM0098765\",\n \"categoryCode\": \"F1\",\n \"category\": \"Finalized\",\n \"claimStatusReasonCode\": \"1\",\n \"claimStatus\": \"Claim/line has been paid\",\n \"payer\": {\n \"info\": {\n \"type\": \"PR\",\n \"name\": \"Sample Payer\",\n \"qualifier\": \"PI\",\n \"id\": \"00001\",\n \"firstName\": null,\n \"middleName\": null\n },\n \"contactInfo\": {\n \"name\": \"Claims Department\",\n \"qualifier\": \"TE\",\n \"number\": \"8005551234\"\n }\n },\n \"providerInfo\": {\n \"type\": \"1P\",\n \"name\": \"lastname\",\n \"qualifier\": \"XX\",\n \"id\": \"1234567890\",\n \"firstName\": null,\n \"middleName\": null\n },\n \"subscriber\": {\n \"type\": \"IL\",\n \"name\": \"lastname\",\n \"qualifier\": \"MI\",\n \"id\": \"memberID\",\n \"firstName\": \"fname\",\n \"middleName\": null\n },\n \"dependent\": null,\n \"claimStatuses\": [\n {\n \"otherIndentificationInfo\": null,\n \"statusInfo\": {\n \"statuses\": [\n {\n \"categoryCode\": \"F1\",\n \"category\": \"Finalized\",\n \"statusCode\": \"1\",\n \"claimStatus\": \"Claim/line has been paid\",\n \"type\": \"Claim\"\n }\n ],\n \"effectiveDate\": \"04/05/2020\",\n \"chrageAmount\": 732.87,\n \"paymentAmount\": 585.42,\n \"adjudicationFinalizedDate\": \"04/05/2020\",\n \"remittanceDate\": \"04/10/2020\",\n \"checkNumber\": \"CHK00019284\"\n },\n \"serviceLines\": [\n {\n \"lineItemInfo\": {\n \"procedureCode\": \"99213\",\n \"lineCharge\": 732.87,\n \"linePayment\": 585.42,\n \"unit\": 1\n },\n \"statusInfo\": {\n \"statuses\": [\n {\n \"categoryCode\": \"F1\",\n \"category\": \"Finalized\",\n \"statusCode\": \"1\",\n \"claimStatus\": \"Claim/line has been paid\",\n \"type\": \"Line\"\n }\n ],\n \"effectiveDate\": \"04/05/2020\"\n },\n \"otherIndentificationInfo\": null,\n \"dates\": [\n {\n \"qualifier\": \"232\",\n \"value\": \"04/01/2020\"\n }\n ]\n }\n ],\n \"dates\": [\n {\n \"qualifier\": \"232\",\n \"value\": \"04/01/2020\"\n }\n ]\n }\n ],\n \"fileControlNumber\": \"FCN0004471123\"\n}\n"},{"id":"e5cf55ba-355b-4729-9fd5-3b86b0df5243","name":"Error - Invalid payer code","originalRequest":{"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 \"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":"| Environment | URL |\n| --- | --- |\n| Test | [https://testapi.pverify.com/API/ClaimStatusInquiry](https://testapi.pverify.com/API/ClaimStatusInquiry) |\n| Production | [https://api.pverify.com/API/ClaimStatusInquiry](https://api.pverify.com/API/ClaimStatusInquiry) |\n\nThe 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).\n\n| Field | Description |\n| --- | --- |\n| URL | [https://api.pverify.com/API/ClaimStatusInquiry](https://api.pverify.com/API/ClaimStatusInquiry) |\n| Method | POST |\n| **Headers** | **Description** |\n| Content-Type | application/json |\n| Authorization | Bearer XXX |\n| Client-API-Id\\* | client-api-id provided by pVerify |\n| **Body** | See right |\n\n\\*Note: The Client-API-Id header is required. Header keys are case sensitive.\n\nNote: The ClaimStatusInquiry for dependents is the same for self. However, it uses different data parameters.\n\n## ClaimStatusInquiry Request Fields for Self\n\n| Property Name | Data Type | Usage | Description |\n| --- | --- | --- | --- |\n| payerCode | String | Required | pVerify payer Code (i.e. Aetna 00001) |\n| ProviderLastName | String | Optional | Provider Last Name |\n| ProviderNPI | String | Conditional | 10-digit NPI value (Not required when ProviderFederalTaxId is available) |\n| ProviderFederalTaxId | String | Conditional | 9 - digit Federal Tax Id (EIN) (not required when NPI is available) |\n| payerClaimNumber | String | Conditional | Payer claim number |\n| chargeAmount | String | Required | Charge Amount |\n| serviceStartDate | String | Required | Start date of service (Expected format: MM/dd/YYYY ie 01/01/2000) |\n| serviceEndDate | String | Required | End date of service (Expected format: MM/dd/YYYY ie 01/01/2000) |\n| subscriber | Object | Required | Subscriber demographic information |\n| subscriber.FirstName | String | Conditional | Subscriber first name |\n| subscriber.lastName | String | Conditional | Subscriber last name |\n| subscriber.dob | String | Conditional | Subscriber Date of Birth (Expected format: MM/dd/YYYY ie 01/01/2000) |\n| subscriber.memberID | String | Conditional | Member ID of subscriber |\n| subscriber.gender | String | Conditional | Gender of subscriber. Allowed M, F or O |\n| isPatientDependent | boolean | Optional | Determines if the patient is dependent |\n\n## ClaimStatusInquiry Request Fields for Dependents\n\n| Property Name | Data Type | Required | Description |\n| --- | --- | --- | --- |\n| payerCode | String | Yes | pVerify payer Code (i.e. Aetna 00001) |\n| ProviderLastName | String | No | Provider Last Name |\n| ProviderNPI | String | Conditional | 10-digit NPI value (Not required when ProviderFederalTaxId is available) |\n| ProviderFederalTaxId | String | Conditional | 9 - digit Federal Tax Id (EIN) (not required when NPI is available) |\n| payerClaimNumber | String | Conditional | Payer claim number |\n| chargeAmount | String | Yes | Charge Amount |\n| serviceStartDate | String | Yes | Start date of service (Expected format: MM/dd/YYYY ie 01/01/2000) |\n| serviceEndDate | String | Yes | End date of service (Expected format: MM/dd/YYYY ie 01/01/2000) |\n| subscriber | Object | Yes | Subscriber demographic information |\n| subscriber.FirstName | String | Conditional | Subscriber first name |\n| subscriber.lastName | String | Conditional | Subscriber last name |\n| subscriber.dob | String | Conditional | Subscriber Date of Birth (Expected format: MM/dd/YYYY ie 01/01/2000) |\n| subscriber.memberID | String | Conditional | Member ID of subscriber |\n| subscriber.gender | String | Conditional | Gender of subscriber.Allowed M, F or O |\n| isPatientDependent | boolean | No | Determines if the patient is dependent |\n| dependent | Object | Conditional | Dependent demographic information |\n| dependent.FirstName | String | Conditional | Dependent first name |\n| dependent.lastName | String | Conditional | Dependent last name |\n| dependent.dob | String | No | Dependent Date of Birth (Expected format: MM/dd/YYYY ie 01/01/2000) |\n| dependent.gender | String | Conditional | Gender of Dependent.Allowed M, F or O |\n\n## ClaimStatusInquiry Response Fields\n\n| Property Name | Data Type | Description |\n| --- | --- | --- |\n| RequestID | Long | Claim Status Request ID |\n| apiResponseCode | int | API transaction response code. Please see apiResponseCode table |\n| apiResponseMessage | String | API transaction response message |\n| ProcessedWithError | String | true when processed with error by the payer. |\n| payerClaimNo | String | Payer Claim Number (if returned in EDI 277) |\n| categoryCode | String | Category code of claim status |\n| category | String | Category of claim status |\n| claimStatusReasonCode | String | Claim Status Code |\n| claimStatus | String | Claim status text |\n| payer | Payer | Contains payer info |\n| providerInfo | Info | Contains provider info |\n| subscriber | Info | Contains Subscriber info |\n| dependent | Info | Contains dependent info |\n| ClaimStatuses | List | Contains Claim Status Info |\n| ClaimStatuses.serviceLine | List | Contains Claim Service line item info, ie: Code specific info |\n\nThe API Response Codes and there description are shown below.\n\n| APIResponseCode | Description |\n| --- | --- |\n| 0 | Processed |\n| 1 | Rejected |\n| 2 | NoFunds (insufficient account balance) |\n| 3 | InvalidRequest (Required data missing) |\n| 4 | InvalidFormat (data format or data fields are wrong) |\n| 5 | InvalidPayer (Payer does not support Claim Status electronically / inactive) |\n| 6 | LocationError (Location is not configured) |"},"status":"OK","code":200,"_postman_previewlanguage":"json","header":[{"key":"Content-Type","value":"application/json"}],"cookie":[],"responseTime":null,"body":"{\n \"apiResponseCode\": 5,\n \"apiResponseMessage\": \"Invalid Payer Code.Please Send correct payer code.\",\n \"requestId\": 0,\n \"processedWithError\": false,\n \"payerClaimNo\": null,\n \"categoryCode\": null,\n \"category\": null,\n \"claimStatusReasonCode\": null,\n \"claimStatus\": null,\n \"payer\": null,\n \"providerInfo\": null,\n \"subscriber\": null,\n \"dependent\": null,\n \"claimStatuses\": null,\n \"fileControlNumber\": null\n}\n"}],"_postman_id":"06a58c55-84f9-4fd7-b426-5ed126209025"},{"name":"GetClaimStatusResponse","id":"9041cf59-2440-4e9d-9cf7-bb28071b0d53","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":"graphql","graphql":{"query":"","variables":""}},"url":"https://apis.pverify.com/API/GetClaimStatusResponse/53","description":"This GET method is used to obtain the transaction result later using a unique request ID. Note: the data is deleted after 90 days.
\nA 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":[{"id":"661acc18-ad10-443d-9029-2579e866704f","name":"Success - Claim status found","originalRequest":{"method":"GET","header":[{"key":"Authorization","value":"Bearer {{access-token}}"},{"key":"Client-API-Id","value":"{{client-api-id}}"},{"key":"Content-Type","value":"application/json"}],"body":{"mode":"graphql","graphql":{"query":"","variables":""}},"url":"https://apis.pverify.com/API/GetClaimStatusResponse/53","description":"| Environment | URL |\n| --- | --- |\n| Test | [https://testapi.pverify.com/API/GetClaimStatusResponse/{requestId}](https://testapi.pverify.com/API/GetClaimStatusResponse/%7BrequestId%7D) |\n| Production | [https://api.pverify.com/API/GetClaimStatusResponse/{requestId}](https://api.pverify.com/API/GetClaimStatusResponse/%7BrequestId%7D) |\n\nThis 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| Field | Description |\n| --- | --- |\n| URL | [https://api.pverify.com/API/GetClaimStatusResponse/{requestId}](https://api.pverify.com/API/GetClaimStatusResponse/%7BrequestId%7D) |\n| Method | GET |\n| **Headers** | **Description** |\n| Authorization | Bearer XXX |\n| Client-API-Id | client-api-id provided through pVerify |\n| Content-Type | application/json |\n| URL Parameters | Unique Request id |\n| Data Parameters | None |\n\nA successful GetClaimStatusResponse call will have the same format as the ClaimStatusInquiry response (above)."},"status":"OK","code":200,"_postman_previewlanguage":"json","header":[{"key":"Content-Type","value":"application/json"}],"cookie":[],"responseTime":null,"body":"{\n \"APIResponseCode\": 0,\n \"APIResponseMessage\": \"Processed\",\n \"RequestId\": 88213345,\n \"ProcessedWithError\": false,\n \"PayerClaimNo\": \"CLM0098765\",\n \"CategoryCode\": \"F1\",\n \"Category\": \"Finalized\",\n \"ClaimStatusReasonCode\": \"1\",\n \"ClaimStatus\": \"Claim/line has been paid\",\n \"Payer\": {\n \"Info\": {\n \"Type\": \"PR\",\n \"Name\": \"Sample Payer\",\n \"Qualifier\": \"PI\",\n \"ID\": \"00001\",\n \"FirstName\": null,\n \"MiddleName\": null\n },\n \"ContactInfo\": {\n \"Name\": \"Claims Department\",\n \"Qualifier\": \"TE\",\n \"Number\": \"8005551234\"\n }\n },\n \"ProviderInfo\": {\n \"Type\": \"1P\",\n \"Name\": \"lastname\",\n \"Qualifier\": \"XX\",\n \"ID\": \"1234567890\",\n \"FirstName\": null,\n \"MiddleName\": null\n },\n \"Subscriber\": {\n \"Type\": \"IL\",\n \"Name\": \"lastname\",\n \"Qualifier\": \"MI\",\n \"ID\": \"memberID\",\n \"FirstName\": \"fname\",\n \"MiddleName\": null\n },\n \"Dependent\": null,\n \"ClaimStatuses\": [\n {\n \"OtherIndentificationInfo\": null,\n \"StatusInfo\": {\n \"Statuses\": [\n {\n \"CategoryCode\": \"F1\",\n \"Category\": \"Finalized\",\n \"StatusCode\": \"1\",\n \"ClaimStatus\": \"Claim/line has been paid\",\n \"Type\": \"Claim\"\n }\n ],\n \"EffectiveDate\": \"04/05/2020\",\n \"ChrageAmount\": 732.87,\n \"PaymentAmount\": 585.42,\n \"AdjudicationFinalizedDate\": \"04/05/2020\",\n \"RemittanceDate\": \"04/10/2020\",\n \"CheckNumber\": \"CHK00019284\"\n },\n \"ServiceLines\": [\n {\n \"LineItemInfo\": {\n \"ProcedureCode\": \"99213\",\n \"LineCharge\": 732.87,\n \"LinePayment\": 585.42,\n \"Unit\": 1\n },\n \"StatusInfo\": {\n \"Statuses\": [\n {\n \"CategoryCode\": \"F1\",\n \"Category\": \"Finalized\",\n \"StatusCode\": \"1\",\n \"ClaimStatus\": \"Claim/line has been paid\",\n \"Type\": \"Line\"\n }\n ],\n \"EffectiveDate\": \"04/05/2020\"\n },\n \"OtherIndentificationInfo\": null,\n \"Dates\": [\n {\n \"Qualifier\": \"232\",\n \"Value\": \"04/01/2020\"\n }\n ]\n }\n ],\n \"Dates\": [\n {\n \"Qualifier\": \"232\",\n \"Value\": \"04/01/2020\"\n }\n ]\n }\n ],\n \"FileControlNumber\": \"FCN0004471123\"\n}\n"},{"id":"1ada6235-8449-4d05-a6d3-b3566abecaed","name":"Error - No result found","originalRequest":{"method":"GET","header":[{"key":"Authorization","value":"Bearer {{access-token}}"},{"key":"Client-API-Id","value":"{{client-api-id}}"},{"key":"Content-Type","value":"application/json"}],"body":{"mode":"graphql","graphql":{"query":"","variables":""}},"url":"https://apis.pverify.com/API/GetClaimStatusResponse/53","description":"| Environment | URL |\n| --- | --- |\n| Test | [https://testapi.pverify.com/API/GetClaimStatusResponse/{requestId}](https://testapi.pverify.com/API/GetClaimStatusResponse/%7BrequestId%7D) |\n| Production | [https://api.pverify.com/API/GetClaimStatusResponse/{requestId}](https://api.pverify.com/API/GetClaimStatusResponse/%7BrequestId%7D) |\n\nThis 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| Field | Description |\n| --- | --- |\n| URL | [https://api.pverify.com/API/GetClaimStatusResponse/{requestId}](https://api.pverify.com/API/GetClaimStatusResponse/%7BrequestId%7D) |\n| Method | GET |\n| **Headers** | **Description** |\n| Authorization | Bearer XXX |\n| Client-API-Id | client-api-id provided through pVerify |\n| Content-Type | application/json |\n| URL Parameters | Unique Request id |\n| Data Parameters | None |\n\nA successful GetClaimStatusResponse call will have the same format as the ClaimStatusInquiry response (above)."},"status":"Not Found","code":404,"_postman_previewlanguage":"json","header":[{"key":"Content-Type","value":"application/json"}],"cookie":[],"responseTime":null,"body":"{\n \"Message\": \"No Result is found.\"\n}\n"}],"_postman_id":"9041cf59-2440-4e9d-9cf7-bb28071b0d53"}],"id":"6c3e355f-ce49-4b7e-aaf0-384e94178971","description":"Checks the status of a previously submitted claim for a subscriber or dependent.
\nGenerate a token.
\nCall ClaimStatusInquiry (POST) with subscriber (and, if applicable, dependent) demographic info plus the claim's charge amount and service dates.
Call GetClaimStatusResponse/{requestId} (GET) to retrieve the result. Note: results are only retained for 90 days.
Dependent inquiries use the same endpoint as self inquiries — set isPatientDependent: true and populate the dependent object alongside subscriber info.
pVerify Payer Code List
Click here to view Payer List
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.
\nNOTE: Used only for EligibilityInquiry endpoint. Please see Practice Type Codes for Eligibility Summary.
\nThis is the pVerify Practice Types available in production for EligiblitySummary endpoints. Practice Types are built around Service Type Codes.
\nPractice Types available under test endpoint
\nThese numeric codes appear on VerificationStatusCode / TransactionStatusCode in a product's response. Each product has its own independent code set — the same number means different things across products.
These PVxxx codes appear in the error/Code field of a failed response, along with a suggested resolution. PV000 is a generic fallback used when no specific code applies.
NOTE: Codes marked with N or field name above include a value substituted at runtime (e.g. the payer's allowed service-code count, or the specific missing field name) — shown here as a placeholder.
\nThese codes originate from the payer or clearinghouse (not pVerify) and may appear alongside or instead of a PVxxx code.