pVerify Dental Eligibility API
Dental insurance eligibility and benefit verification, including the only version-prefixed path in the pVerify surface (/api/v2/DentalEligibilitySummary) alongside the unversioned v1 endpoints.
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OpenAPI Specification
openapi: 3.2.0
info:
title: pVerify Dental Eligibility API
description: Real-time healthcare insurance eligibility and revenue-cycle API. Derived operation-for-operation from the public Postman collection pVerify publishes at https://postman.pverify.com/ (collection 6ceb8797-50ff-42fd-98a3-64beefaa6c94, last updated 03/01/2026). Covers eligibility (270/271), dental eligibility, insurance discovery, MBI lookup, patient demographic validation, claim status (276/277), patient cost estimation, payer lists and the CGX widget.
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: Dental Eligibility
paths:
/API/GetEligibilitySummary/{requestId}:
get:
operationId: getEligibilitySummary
tags:
- Dental Eligibility
summary: GetEligibilitySummary
description: 'Environment |
URL |
Test |
https://testapi.pverify.com/API/GetEligibilitySummary |
Production |
https://api.pverify.com/API/GetEligibilitySummary |
GetEligibilitySummary returns the response from the EligibilitySummary POST call using a unique request id provided in the EligibilitySummary response. EligibilitySummary is not supported for back office payers.
Headers
Key |
Value |
URL |
https://api.pverify.com/API/GetEligibilitySummary |
Method |
GET |
Headers |
Description |
Authorization |
Authorization token from above preceded by the String "Bearer" |
Client-API-Id* |
Your pVerify client-api-id |
Client-API-Id |
API ID provided by pVerify |
Content-Type |
application/json |
URL Parameters |
RequestId returned in EligibilitySummary response |
*Note: The Client-API-Id header is required. Header keys are case sensitive.
GetEligibilitySummary Response Fields
Key |
Type |
Description |
RequestID |
Integer |
Eligibility Transaction ID |
APIResponseCode |
Integer |
0-Processed,1-Rejected |
APIResponseMessage |
String |
Message about the transaction |
VerificationType |
String |
Verification Type –Subscriber or dependent |
VerificationStatus |
String |
Eligibility Transaction Status- Values : Processed, Pending, Rejected |
DOS |
String |
Date of service start date – DOS end date |
Is HMO Plan |
Boolean |
If true then Patient has HMO plan |
ExceptionNotes |
String |
Exception Notes if any. If response demographic info is not matched with that of Request |
AddtionalInformation |
String |
If there is any other info |
DemographicInfo |
Object |
It contains the subscriber info or dependent info |
ServiceDetails |
Object |
It contains all Service type details info |
OtherPayerInfo |
Object |
It contains Other Payer info. It is null then there is no payer change. |
PlanCoverageSummary |
object |
It contains Plan realted info. |
DentalInfo |
Object |
It contains response as formatted HTML response when IncludeHTMLResponse of request is true. |'
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: []
/api/DentalEligibilitySummary:
post:
operationId: dentalEligibilitySummary
tags:
- Dental Eligibility
summary: DentalEligibilitySummary
description: 'There two type of verifications Self and Dependent.
DentalEligibilitySummary Request Details
Property Name |
Data Type |
Usage |
Description |
PayerCode |
String |
Required |
pVerify payer Code or Client payer map code (i.e. Delta Dental of WH-DE0171) |
PayerName |
String |
Optional |
Payer Name |
Provider.FirstName |
String |
Optional |
Provider first name |
Provider.LastName |
String |
Required |
Provider last name |
Provider.NPI |
String |
Required |
10-digit NPI value |
Provider.TaxId |
String |
Required |
Tax Id |
Subscriber.FirstName |
String |
Conditional |
First Name of subscriber required for self-inquiry |
Subscriber.LastName |
String |
Conditional |
Last Name of subscriber required for self-inquiry |
Subscriber.MemberId |
String |
Required |
Member Id required for both type inquiries (self, dependent) |
Subscriber.DOB |
String |
Conditional |
Required for self-inquiry for better matching result Format is MM/dd/yyyy |
Subscriber.SSN |
String |
Optional |
SSN of subscriber |
isSubscriberPatient |
String |
Required |
True for self and False for Dependent inquiry |
doS_StartDate |
String |
Required |
Date of service start date in MM/dd/yyyy format |
doS_EndDate |
String |
Required |
Date of service end date in MM/dd/yyyy format |
PracticeTypeCode |
Number |
Optional |
Default practice type is 86 |
Location |
String |
Optional |
Default is clients default location. |
ReferenceId |
String |
Optional |
Any refence Id,for ex: Patient MRN |
IncludeHTMLResponse |
Boolean |
Optional |
Default is false, if true then Entire response will be returned as formatted text in Response Test along with Summary details. |
Dependent |
Object |
Conditional |
Required for dependent inquiry |
Dependent.Patient.FirstName |
String |
Conditional |
First Name of dependent required for dependent inquiry |
Dependent.Patient.LastName |
String |
Conditional |
Last Name of dependent required for dependent inquiry |
Dependent.Patient.DOB |
String |
Conditional |
Required for dependent inquiry for better matching result Format is MM/dd/yyyy |
DCodes |
Object |
Conditional |
Dental Diagnosis Codes to get coinsurance and Deductible values |
DentalEligibilitySummary Response details
Key |
Type |
Description |
RequestID |
Integer |
Eligibility Transaction ID |
APIResponseCode |
String |
0-Processed,1-Rejected,3-Pending |
APIResponseMessage |
String |
Message about the transaction |
VerificationType |
String |
Verification Type –Subscriber or dependent |
DOS |
String |
Date of service start date – DOS end date |
Is HMO Plan |
Boolean |
If true then Patient has HMO plan |
ExceptionNotes |
String |
"Exception Notes if any . If response demographic info is not matched with that of Request" |
AdditionalInformation |
String |
If there is any other info |
DemographicInfo |
Object |
It contains the subscriber info or dependent info . |
ServiceDetails |
Object |
"It contains all Service type details info" |
PreventiveServices |
Object |
Contains Preventive codes details |
OtherPayerInfo |
Object |
It contains Other Payer info. It is null then there is no payer change. |
PlanCoverageSummary |
object |
It contains Plan related info. |
DentalInfo |
Object |
It contains response as formatted HTML response when IncludeHTMLResponse of request is true. |
ResponseText |
String |
|
DCodes |
Object |
It contains the dental diagnosis codes used for deductible and coinsurance values |'
requestBody:
required: true
content:
application/json:
schema:
type: object
properties:
payerCode:
type: string
example: DE0171
payerName:
type: string
example: Delta Dental of Washington
provider:
type: object
properties:
firstName:
type: string
middleName:
type: string
lastName:
type: string
example: ' test name'
npi:
type: string
example: '1427006147'
TaxId:
type: string
example: '123456789'
subscriber:
type: object
properties:
firstName:
type: string
dob:
type: string
example: 01/01/1950
lastName:
type: string
memberID:
type: string
example: '1234567890'
dependent: {}
isSubscriberPatient:
type: string
example: 'True'
doS_StartDate:
type: string
example: 02/02/2021
doS_EndDate:
type: string
example: 02/02/2021
PracticeTypeCode:
type: string
example: '86'
referenceId:
type: string
example: Pat MRN
Location:
type: string
example: Any location Name
IncludeHtmlResponse:
type: boolean
example: false
dCodes:
type: array
items:
type: string
example: D0120
example:
payerCode: DE0171
payerName: Delta Dental of Washington
provider:
firstName: ''
middleName: ''
lastName: ' test name'
npi: '1427006147'
TaxId: '123456789'
subscriber:
firstName: ''
dob: 01/01/1950
lastName: ''
memberID: '1234567890'
dependent: null
isSubscriberPatient: 'True'
doS_StartDate: 02/02/2021
doS_EndDate: 02/02/2021
PracticeTypeCode: '86'
referenceId: Pat MRN
Location: Any location Name
IncludeHtmlResponse: false
dCodes:
- D0120
- D0145
responses:
'200':
description: OK
security:
- bearerAuth: []
clientApiId: []
/api/DentalEligibilityBenefitSummary:
post:
operationId: dentalEligibilityBenefitSummary
tags:
- Dental Eligibility
summary: DentalEligibilityBenefitSummary
description: 'There two type of verifications Self and Dependent.
DentalEligibilityBenefitSummary Request Details
Property Name |
Data Type |
Usage |
Description |
PayerCode |
String |
Required |
pVerify payer Code or Client payer map code (i.e. Delta Dental of WH-DE0171) |
PayerName |
String |
Optional |
Payer Name |
Provider.FirstName |
String |
Optional |
Provider first name |
Provider.LastName |
String |
Required |
Provider last name |
Provider.NPI |
String |
Required |
10-digit NPI value |
Provider.TaxId |
String |
Required |
Tax Id |
Subscriber.FirstName |
String |
Conditional |
First Name of subscriber required for self-inquiry |
Subscriber.LastName |
String |
Conditional |
Last Name of subscriber required for self-inquiry |
Subscriber.MemberId |
String |
Required |
Member Id required for both type inquiries (self, dependent) |
Subscriber.DOB |
String |
Conditional |
Required for self-inquiry for better matching result Format is MM/dd/yyyy |
Subscriber.SSN |
String |
Optional |
SSN of subscriber |
isSubscriberPatient |
String |
Required |
True for self and False for Dependent inquiry |
doS_StartDate |
String |
Required |
Date of service start date in MM/dd/yyyy format |
doS_EndDate |
String |
Required |
Date of service end date in MM/dd/yyyy format |
PracticeTypeCode |
Number |
Optional |
Default practice type is 86 |
Location |
String |
Optional |
Default is clients default location. |
ReferenceId |
String |
Optional |
Any refence Id,for ex: Patient MRN |
IncludeHTMLResponse |
Boolean |
Optional |
Default is false, if true then Entire response will be returned as formatted text in Response Test along with Summary details. |
Dependent |
Object |
Conditional |
Required for dependent inquiry |
Dependent.Patient.FirstName |
String |
Conditional |
First Name of dependent required for dependent inquiry |
Dependent.Patient.LastName |
String |
Conditional |
Last Name of dependent required for dependent inquiry |
Dependent.Patient.DOB |
String |
Conditional |
Required for dependent inquiry for better matching result Format is MM/dd/yyyy |
DentalEligibilityBenefitSummary Response details
Key |
Type |
Description |
RequestID |
Integer |
Eligibility Transaction ID |
APIResponseCode |
String |
0-Processed,1-Rejected,3-Pending |
APIResponseMessage |
String |
Message about the transaction |
VerificationType |
String |
Verification Type –Subscriber or dependent |
DOS |
String |
Date of service start date – DOS end date |
Is HMO Plan |
Boolean |
If true then Patient has HMO plan |
ExceptionNotes |
String |
"Exception Notes if any . If response demographic info is not matched with that of Request" |
AdditionalInformation |
String |
If there is any other info |
DemographicInfo |
Object |
It contains the subscriber info or dependent info . |
BenefitDetails |
Object |
It contains all details info group by Benefit type. Ex ; Dedcutible, Co-pay. |
PreventiveServices |
Object |
Contains Preventive codes details |
OtherPayerInfo |
Object |
It contains Other Payer info. It is null then there is no payer change. |
PlanCoverageSummary |
object |
It contains Plan related info. |
DentalInfo |
Object |
It contains response as formatted HTML response when IncludeHTMLResponse of request is true. |
ResponseText |
String |
|'
requestBody:
required: true
content:
application/json:
schema:
type: object
properties:
payerCode:
type: string
example: DE0171
payerName:
type: string
example: Delta Dental of Washington
provider:
type: object
properties:
firstName:
type: string
middleName:
type: string
lastName:
type: string
example: ' test name'
npi:
type: string
example: '1427006147'
TaxId:
type: string
example: '123456789'
subscriber:
type: object
properties:
firstName:
type: string
dob:
type: string
example: 01/01/1950
lastName:
type: string
memberID:
type: string
example: '1234567890'
dependent: {}
isSubscriberPatient:
type: string
example: 'True'
doS_StartDate:
type: string
example: 02/02/2021
doS_EndDate:
type: string
example: 02/02/2021
PracticeTypeCode:
type: string
example: '86'
referenceId:
type: string
example: Pat MRN
Location:
type: string
example: Any location Name
IncludeHtmlResponse:
type: boolean
example: false
example:
payerCode: DE0171
payerName: Delta Dental of Washington
provider:
firstName: ''
middleName: ''
lastName: ' test name'
npi: '1427006147'
TaxId: '123456789'
subscriber:
firstName: ''
dob: 01/01/1950
lastName: ''
memberID: '1234567890'
dependent: null
isSubscriberPatient: 'True'
doS_StartDate: 02/02/2021
doS_EndDate: 02/02/2021
PracticeTypeCode: '86'
referenceId: Pat MRN
Location: Any location Name
IncludeHtmlResponse: false
responses:
'200':
description: OK
security:
- bearerAuth: []
clientApiId: []
/api/v2/DentalEligibilitySummary:
post:
operationId: dentalEligibilitySummaryV2
tags:
- Dental Eligibility
summary: V2 DentalEligibilitySummary
description: There two type of verifications Self and Dependent.
requestBody:
required: true
content:
application/json:
schema:
type: object
properties:
payerCode:
type: string
example: DE0171
payerName:
type: string
example: Delta Dental of Washington
provider:
type: object
properties:
firstName:
type: string
middleName:
type: string
lastName:
type: string
example: ' test name'
npi:
type: string
example: '1234567890'
TaxId:
type: string
example: '123456789'
subscriber:
type: object
properties:
firstName:
type: string
example: firstname
dob:
type: string
example: 12/31/1967
lastName:
type: string
example: lastname
memberID:
type: string
example: 123456789A
dependent: {}
isSubscriberPatient:
type: string
example: 'True'
doS_StartDate:
type: string
example: 05/20/2026
doS_EndDate:
type: string
example: 05/20/2026
PracticeTypeCode:
type: string
example: '211'
referenceId:
type: string
example: MRN001
Location:
type: string
example: TestLocation01
dCodes:
type: array
items:
type: string
example: D0140
example:
payerCode: DE0171
payerName: Delta Dental of Washington
provider:
firstName: ''
middleName: ''
lastName: ' test name'
npi: '1234567890'
TaxId: '123456789'
subscriber:
firstName: firstname
dob: 12/31/1967
lastName: lastname
memberID: 123456789A
dependent: null
isSubscriberPatient: 'True'
doS_StartDate: 05/20/2026
doS_EndDate: 05/20/2026
PracticeTypeCode: '211'
referenceId: MRN001
Location: TestLocation01
dCodes:
- D0140
- D0150
- D0170
responses:
'200':
description: OK
security:
- bearerAuth: []
clientApiId: []
/API/GetDentalEligibilitySummary/{requestId}:
get:
operationId: getDentalEligibilitySummary
tags:
- Dental Eligibility
summary: GetDentalEligibilitySummary
description: 'Environment |
URL |
Test |
https://testapi.pverify.com/API/V2/GetDentalEligibilitySummary |
Production |
https://api.pverify.com/API/V2/GetDentalEligibilitySummary |
GetEligibilitySummary returns the response from the EligibilitySummary POST call using a unique request id provided in the EligibilitySummary response.'
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.