pVerify Claim Status API

openapi: 3.2.0
info:
  title: pVerify Claim Status API
  description: pVerify Claim Status API, derived operation-for-operation from the public Postman collection pVerify publishes at https://postman.pverify.com/ (last updated 03/01/2026). All calls require an OAuth2 bearer token from POST /Token plus the Client-API-Id header.
  version: '1.0'
  termsOfService: https://pverify.com/privacy-policy/
  contact:
    name: pVerify Support
    email: support@pverify.com
    url: https://pverify.com/contact-support/
servers:
- url: https://api.pverify.com
  description: Production
- url: https://testapi.pverify.com
  description: Test environment published by pVerify
tags:
- name: Claim Status
paths:
  /API/ClaimStatusInquiry:
    post:
      operationId: claimStatusInquiry
      tags:
      - Claim Status
      summary: ClaimStatusInquiry
      description: "Environment | \nURL | \n\nTest | \nhttps://testapi.pverify.com/API/ClaimStatusInquiry | \n\nProduction | \nhttps://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\nField | \nDescription | \n\nURL | \nhttps://api.pverify.com/API/ClaimStatusInquiry | \n\nMethod | \nPOST | \n\nHeaders | \nDescription | \n\nContent-Type | \napplication/json | \n\nAuthorization | \nBearer XXX | \n\nClient-API-Id* | \nclient-api-id provided by pVerify | \n\nBody | \nSee 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\nClaimStatusInquiry Request Fields for Self\n\nProperty Name | \nData Type | \nUsage | \nDescription | \n\npayerCode | \nString | \nRequired | \npVerify payer Code (i.e. Aetna 00001) | \n\nProviderLastName | \nString | \nOptional | \nProvider Last Name | \n\nProviderNPI | \nString | \nConditional | \n10-digit NPI value (Not required when ProviderFederalTaxId is available) | \n\nProviderFederalTaxId | \nString | \nConditional | \n9 - digit Federal Tax Id (EIN) (not required when NPI is available) | \n\npayerClaimNumber | \nString | \nConditional | \nPayer claim number | \n\nchargeAmount | \nString | \nRequired | \nCharge Amount | \n\nserviceStartDate | \nString | \nRequired | \nStart date of service (Expected format: MM/dd/YYYY ie 01/01/2000) | \n\nserviceEndDate | \nString | \nRequired | \nEnd date of service (Expected format: MM/dd/YYYY ie 01/01/2000) | \n\nsubscriber | \nObject | \nRequired | \nSubscriber demographic information | \n\nsubscriber.FirstName | \nString | \nConditional | \nSubscriber first name | \n\nsubscriber.lastName | \nString | \nConditional | \nSubscriber last name | \n\nsubscriber.dob | \nString | \nConditional | \nSubscriber Date of Birth (Expected format: MM/dd/YYYY ie 01/01/2000) | \n\nsubscriber.memberID | \nString | \nConditional | \nMember ID of subscriber | \n\nsubscriber.gender | \nString | \nConditional | \nGender of subscriber. Allowed M, F or O | \n\nisPatientDependent | \nboolean | \nOptional | \nDetermines if the patient is dependent | \n\nClaimStatusInquiry Request Fields for Dependents\n\nProperty Name | \nData Type | \nRequired | \nDescription | \n\npayerCode | \nString | \nYes | \npVerify payer Code (i.e. Aetna 00001) | \n\nProviderLastName | \nString | \nNo | \nProvider Last Name | \n\nProviderNPI | \nString | \nConditional | \n10-digit NPI value (Not required when ProviderFederalTaxId is available) | \n\nProviderFederalTaxId | \nString | \nConditional | \n9 - digit Federal Tax Id (EIN) (not required when NPI is available) | \n\npayerClaimNumber | \nString | \nConditional | \nPayer claim number | \n\nchargeAmount | \nString | \nYes | \nCharge Amount | \n\nserviceStartDate | \nString | \nYes | \nStart date of service (Expected format: MM/dd/YYYY ie 01/01/2000) | \n\nserviceEndDate | \nString | \nYes | \nEnd date of service (Expected format: MM/dd/YYYY ie 01/01/2000) | \n\nsubscriber | \nObject | \nYes | \nSubscriber demographic information | \n\nsubscriber.FirstName | \nString | \nConditional | \nSubscriber first name | \n\nsubscriber.lastName | \nString | \nConditional | \nSubscriber last name | \n\nsubscriber.dob | \nString | \nConditional | \nSubscriber Date of Birth (Expected format: MM/dd/YYYY ie 01/01/2000) | \n\nsubscriber.memberID | \nString | \nConditional | \nMember ID of subscriber | \n\nsubscriber.gender | \nString | \nConditional | \nGender of subscriber.Allowed M, F or O | \n\nisPatientDependent | \nboolean | \nNo | \nDetermines if the patient is dependent | \n\ndependent | \nObject | \nConditional | \nDependent demographic information | \n\ndependent.FirstName | \nString | \nConditional | \nDependent first name | \n\ndependent.lastName | \nString | \nConditional | \nDependent last name | \n\ndependent.dob | \nString | \nNo | \nDependent Date of Birth (Expected format: MM/dd/YYYY ie 01/01/2000) | \n\ndependent.gender | \nString | \nConditional | \nGender of Dependent.Allowed M, F or O | \n\nClaimStatusInquiry Response Fields\n\nProperty Name | \nData Type | \nDescription | \n\nRequestID | \nLong | \nClaim Status Request ID | \n\napiResponseCode | \nint | \nAPI transaction response code. Please see apiResponseCode table | \n\napiResponseMessage | \nString | \nAPI transaction response message | \n\nProcessedWithError | \nString | \ntrue when processed with error by the payer. | \n\npayerClaimNo | \nString | \nPayer Claim Number (if returned in EDI 277) | \n\ncategoryCode | \nString | \nCategory code of claim status | \n\ncategory | \nString | \nCategory of claim status | \n\nclaimStatusReasonCode | \nString | \nClaim Status Code | \n\nclaimStatus | \nString | \nClaim status text | \n\npayer | \nPayer | \nContains payer info | \n\nproviderInfo | \nInfo | \nContains provider info | \n\nsubscriber | \nInfo | \nContains Subscriber info | \n\ndependent | \nInfo | \nContains dependent info | \n\nClaimStatuses | \nList | \nContains Claim Status Info | \n\nClaimStatuses.serviceLine | \nList | \nContains Claim Service line item info, ie: Code specific info | \n\nThe API Response Codes and there description are shown below.\n\nAPIResponseCode | \nDescription | \n\n0 | \nProcessed | \n\n1 | \nRejected | \n\n2 | \nNoFunds (insufficient account balance) | \n\n3 | \nInvalidRequest (Required data missing) | \n\n4 | \nInvalidFormat (data format or data fields are wrong) | \n\n5 | \nInvalidPayer (Payer does not support Claim Status electronically / inactive) | \n\n6 | \nLocationError (Location is not configured) |"
      requestBody:
        required: true
        content:
          application/json:
            schema:
              type: object
              properties:
                payerCode:
                  type: string
                  example: '00001'
                ProviderLastName:
                  type: string
                  example: lastname
                ProviderNPI:
                  type: string
                  example: '1234567890'
                ProviderFederalTaxId:
                  type: string
                payerClaimNumber:
                  type: string
                chargeAmount:
                  type: number
                  example: 732.87
                serviceStartDate:
                  type: string
                  example: 04/01/2020
                serviceEndDate:
                  type: string
                  example: 04/01/2020
                subscriber:
                  type: object
                  properties:
                    FirstName:
                      type: string
                    lastName:
                      type: string
                      example: lastname
                    dob:
                      type: string
                      example: 07/07/2010
                    memberID:
                      type: string
                      example: memberID
                    gender: {}
                isPatientDependent:
                  type: boolean
                  example: false
            example:
              payerCode: '00001'
              ProviderLastName: lastname
              ProviderNPI: '1234567890'
              ProviderFederalTaxId: ''
              payerClaimNumber: ''
              chargeAmount: 732.87
              serviceStartDate: 04/01/2020
              serviceEndDate: 04/01/2020
              subscriber:
                FirstName: ''
                lastName: lastname
                dob: 07/07/2010
                memberID: memberID
                gender: null
              isPatientDependent: false
      responses:
        '200':
          description: OK
      security:
      - bearerAuth: []
        clientApiId: []
  /API/GetClaimStatusResponse/{requestId}:
    get:
      operationId: getClaimStatusResponse
      tags:
      - Claim Status
      summary: GetClaimStatusResponse
      description: "Environment | \nURL | \n\nTest | \nhttps://testapi.pverify.com/API/GetClaimStatusResponse/{requestId} | \n\nProduction | \nhttps://api.pverify.com/API/GetClaimStatusResponse/{requestId} | \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\nField | \nDescription | \n\nURL | \nhttps://api.pverify.com/API/GetClaimStatusResponse/{requestId} | \n\nMethod | \nGET | \n\nHeaders | \nDescription | \n\nAuthorization | \nBearer XXX | \n\nClient-API-Id | \nclient-api-id provided through pVerify | \n\nContent-Type | \napplication/json | \n\nURL Parameters | \nUnique Request id | \n\nData Parameters | \nNone | \n\nA successful GetClaimStatusResponse call will have the same format as the ClaimStatusInquiry response (above)."
      parameters:
      - name: requestId
        in: path
        required: true
        schema:
          type: string
        description: Unique pVerify transaction / request id returned by the matching inquiry call.
      responses:
        '200':
          description: OK
      security:
      - bearerAuth: []
        clientApiId: []
components:
  securitySchemes:
    bearerAuth:
      type: http
      scheme: bearer
      description: 'OAuth2 access token returned by POST /Token, sent as `Authorization: Bearer <token>`.'
    clientApiId:
      type: apiKey
      in: header
      name: Client-API-Id
      description: Client API identifier issued by pVerify. Required on every call; header keys are case sensitive.
    clientSecret:
      type: apiKey
      in: header
      name: Client-Secret
      description: Client secret issued by pVerify, used by the one-step (no-token) endpoints and the premium report endpoints.