{"activeVersionTag":"latest","latestAvailableVersionTag":"latest","collection":{"info":{"_postman_id":"6ceb8797-50ff-42fd-98a3-64beefaa6c94","name":"pVerify API Documentation","description":"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.\n\n## Where to start\n\nMost integrations begin with one of two calls:\n\n- **Eligibility** — verify a patient's active coverage, benefits, and copays with a known payer. Covers medical and dental (see **Dental Eligibility**).\n    \n- **Insurance Discovery** — find a patient's coverage when you don't yet know their payer or member ID.\n    \n\nFrom there, pVerify supports a broader set of tools for specific situations:\n\n| Product | Use it when |\n| --- | --- |\n| **MBI Lookup** | You already suspect a patient is Medicare-eligible and just need their identifier — cheaper and faster than a full Insurance Discovery check |\n| **Patient Demographic Validator** | You need to confirm or find a patient record using whatever demographic details you have, independent of insurance |\n| **Claim Status Inquiry** | You need the status of a claim you've already submitted |\n| **Patient Cost Estimator** | You need to estimate a patient's out-of-pocket cost for specific CPT codes, based on CMS Medicare pricing |\n\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.\n\n## Authentication\n\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.\n\n## Real-time vs. Back-office Payers\n\nAlmost 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.\n\n## Environments\n\nMost endpoints follow the same pattern:\n\n| Environment | URL |\n| --- | --- |\n| Test | `https://testapi.pverify.com` |\n| Production | `https://api.pverify.com` |\n\n**One exception:** Patient Cost Estimator has no test environment — it's production-only.\n\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/](https://pverify.com/request-a-demo/)\n\n## A Note on Response Patterns\n\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.\n\n## A Note on Patient Data\n\npVerify 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.","schema":"https://schema.getpostman.com/json/collection/v2.0.0/collection.json","isPublicCollection":true,"owner":"6948370","team":294840,"collectionId":"6ceb8797-50ff-42fd-98a3-64beefaa6c94","publishedId":"2s7ZE4NR6P","public":true,"publicUrl":"https://postman.pverify.com","privateUrl":"https://go.postman.co/documentation/6948370-6ceb8797-50ff-42fd-98a3-64beefaa6c94","customColor":{"top-bar":"FFFFFF","right-sidebar":"002B49","highlight":"028684"},"documentationLayout":"classic-double-column","customisation":{"metaTags":[{"name":"description","value":"eligibility & Benefit verification , Insurance discovery"},{"name":"title","value":"Eligibility and Insurance discovery API 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