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openapi: 3.2.0
info:
title: pVerify Eligibility API
description: pVerify Eligibility 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
- url: https://premium.pverify.com
description: pVerify premium portal host (PDF reports, widget setup)
tags:
- name: Eligibility
paths:
/api/EligibilitySummary:
post:
operationId: eligibilitySummary
tags:
- Eligibility
summary: EligibilitySummary
description: "Environment | \nURL | \n\nTest | \nhttps://testapi.pverify.com/API/EligibilitySummary | \n\nProduction | \nhttps://api.pverify.com/API/EligibilitySummary | \n\nEligibility summary is our 2nd gen eligibility endpoint designed to cover the vast majority of payers and return simplified objects with key data such as copay for your practice type. For example, when you send as practice type PT, we will return a Physical Therapy object with key PT benefits.\n\nKey benefits are:\n\nEasy and discrete eligibility information, allowing easy coding to obtain pertinent data.\n\nSupport for nearly all types of medical practices with key benefits such as surgical benefits, DME benefits, or PT benefits.\n\nSupport for nearly all payers, electronic and non electronic. We have tested all payers available to us and over 90% are returning parsed information correctly\n\nTo see the currently supported practice types please see the Practice Type tables.\n\nMedicareWe 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.\n\nRecursive Medicare Advantage LookupThis will need to be enabled by us, so please contact us at support@pverify.com. When enabled, we will automatically perform a eligibility check (using Eligibility Summary) on selected MCA payers that allow lookup by MBI or Name & DOB. If the can be done, the result is returned in a field RecursiveRequestId.\n\nThus the workflow is this:\n\nSubmit eligibility call to Medicare via Eligibility Summary. \n\nCapture RecursiveRequestId. \n\nRun a GET call (GetEligibilitySummary) using this Id.\n\nHeaders\n\nKey | \nValue | \n\nURL | \nhttps://api.pverify.com/API/EligibilitySummary | \n\nMethod | \nPOST | \n\nHeaders | \nDescription | \n\nAuthorization | \nAuthorization token from above preceded by the String \"Bearer\" | \n\nClient-API-Id | \nAPI ID provided by pVerify | \n\nContent-Type | \napplication/json | \n\n*Note: The Client-API-Id is required. Header keys are case sensitive.\n\nEligibilitySummary Request Details\n\nProperty Name | \nData Type | \nUsage | \nDescription | \n\npayerCode | \nString | \nRequired | \npVerify Payer Code(ie Aetna 00001) | \n\npayerName | \nString | \nOptional | \nPayer Name | \n\nprovider.firstName | \nString | \nOptional | \nProvider First Name | \n\nprovider.middleName | \nString | \nOptional | \nProvider Middle Name | \n\nprovider.lastName | \nString | \nRequired | \nProvider Last Name | \n\nprovider.npi | \nString | \nRequired | \n10-Digit NPI Value | \n\nprovider.pin | \nString | \nConditional | \nRequired for payer Medi-Cal | \n\nprovider.taxonomy | \nString | \nOptional | \nTaxonomy | \n\nsubscriber.firstName | \nString | \nConditional | \nFirst Name of subscriber required for self inquiry | \n\nsubscriber.lastName | \nString | \nConditional | \nLast Name of subscriber required for self inquiry | \n\nsubscriber.memberId | \nString | \nRequired | \nMember Id required for both type inquiries(self,dependent) | \n\nsubscriber.dob | \nString | \nConditional | \nRequired for self-inquiry for better matching result. (Expected format: MM/dd/YYYY ie 01/01/2000) | \n\nsubscriber.ssn | \nString | \nOptional | \nSSN of Subscriber | \n\nisSubscriberPatient | \nString | \nRequired | \nTrue for self and False for Dependent Query | \n\ndoS_StartDate | \nString | \nRequired | \nDate of service start date (Expected format: MM/dd/YYYY ie 01/01/2000) | \n\ndoS_EndDate | \nString | \nRequired | \nDate of service end date (Expected format: MM/dd/YYYY ie 01/01/2000) | \n\ndependent.patient.firstName | \nString | \nConditional | \nFirst Name of dependent | \n\ndependent.patient.middleName | \nString | \nOptional | \nMiddle Name of dependent | \n\ndependent.patient.lastName | \nString | \nConditional | \nLast Name of dependent | \n\ndependent.patient.dob | \nString | \nConditional | \nRequired for dependent inquiry. (Expected format: MM/dd/YYYY ie 01/01/2000) | \n\ndependent.patient.gender | \nString | \nOptional | \nGender of dependent | \n\ndependent.relationWithSubscriber | \nString | \nOptional | \nRelation With Subscriber | \n\npracticeTypeCode | \nString | \nOptional | \nPlease consult Practice Type Code table - sets which practice type to use, i.e. 12 for physical therapy, which will return an object with PT benefits in the results. If you do not select a practice type, the default for your account will be used. Contact pVerify for more info. | \n\nincludeTextResponse | \nBoolean | \nOptional | \nIndicates whether to return the full text of the eligibility response | \n\nreferenceId | \nString | \nOptional | \nPatient MRN or account Number | \n\nlocation | \nString | \nRequired | \nLocation is the practice location. Note by setting this, you will lock the patient to one location, so that users that login in via our portal who are not authorized to see that location will not see the patient. | \n\ninternalId | \nString | \nOptional | \nField from customer with their InternalId | \n\ncustomerId | \nString | \nOptional | \nField from customer with their CustomerId | \n\nPlaceOfService | \nstring | \noptional | \nPlace of service | \n\nEligibilitySummary Response Fields\n\nKey | \nType | \nDescription | \n\nRequestID | \nInteger | \nEligibility Transaction ID | \n\nAPIResponseCode | \nString | \n0-Processed,1-Rejected,2-NoFunds,3-Pending,4-New | \n\nAPIResponseMessage | \nString | \nMessage about the transaction | \n\nProcessedWithError | \nBoolean | \ntrue when processed with error by the payer. | \n\nEDIErrorMessage | \nString | \nMessage from Payer about errors | \n\nFollowUpAction | \nString | \nResponse from the Payer | \n\nPossibleResolution | \nString | \nSuggested steps to be performed before resubmitting to resolve the issue. | \n\nPverifyPayerCode | \nString | \npVerify’s Payer Code | \n\nErrorCode | \nString | \nIt contains unique error Code when Processed with error or Rejected | \n\nErrorDescription | \nString | \nIt contians description of the error. | \n\nPayerN"
requestBody:
required: true
content:
application/json:
schema:
type: object
properties:
payerCode:
type: string
example: 00192
payerName:
type: string
example: UHC
provider:
type: object
properties:
firstName:
type: string
middleName:
type: string
lastName:
type: string
example: ' provider last name'
npi:
type: string
example: '1234567890'
pin:
type: string
example: '00000'
subscriber:
type: object
properties:
firstName:
type: string
example: fname
dob:
type: string
example: mm/dd/yyyy
lastName:
type: string
example: lname
memberID:
type: string
example: 123sfadfaf
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: '3'
referenceId:
type: string
example: Pat MRN
Location:
type: string
example: Any location Name
IncludeTextResponse:
type: string
example: 'false'
InternalId:
type: string
CustomerID:
type: string
PlaceOfService:
type: string
example: '01'
example:
payerCode: 00192
payerName: UHC
provider:
firstName: ''
middleName: ''
lastName: ' provider last name'
npi: '1234567890'
pin: '00000'
subscriber:
firstName: fname
dob: mm/dd/yyyy
lastName: lname
memberID: 123sfadfaf
dependent: null
isSubscriberPatient: 'True'
doS_StartDate: 02/02/2021
doS_EndDate: 02/02/2021
PracticeTypeCode: '3'
referenceId: Pat MRN
Location: Any location Name
IncludeTextResponse: 'false'
InternalId: ''
CustomerID: ''
PlaceOfService: '01'
responses:
'200':
description: OK
security:
- bearerAuth: []
clientApiId: []
/API/GetEligibilitySummary/{requestId}:
get:
operationId: getEligibilitySummary
tags:
- Eligibility
summary: GetEligibilitySummary
description: "Environment | \nURL | \n\nTest | \nhttps://testapi.pverify.com/API/GetEligibilitySummary | \n\nProduction | \nhttps://api.pverify.com/API/GetEligibilitySummary | \n\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.\n\nHeaders\n\nKey | \nValue | \n\nURL | \nhttps://api.pverify.com/API/GetEligibilitySummary | \n\nMethod | \nGET | \n\nHeaders | \nDescription | \n\nAuthorization | \nAuthorization token from above preceded by the String \"Bearer\" | \n\nClient-API-Id* | \nYour pVerify client-api-id | \n\nClient-API-Id | \nAPI ID provided by pVerify | \n\nContent-Type | \napplication/json | \n\nURL Parameters | \nRequestId returned in EligibilitySummary response | \n\n*Note: The Client-API-Id header is required. Header keys are case sensitive.\n\nGetEligibilitySummary Response Fields\n\nSee 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: []
/API/GetEligibility271/{requestId}:
get:
operationId: getEligibility271
tags:
- Eligibility
summary: GetEligibility271
description: "Environment | \nURL | \n\nTest | \nhttps://testapi.pverify.com/API/GetEligibility271/{id} | \n\nProduction | \nhttps://api.pverify.com/API/GetEligibility271/{id} | \n\nThis GET method will return EDI 271 Raw response with Eligibility Request ID as a parameter.\n\nGetEligibility271 Request\n\nKey | \nValue | \n\nURL | \nhttps://api.pverify.com/API/GetEligibility271/{id} | \n\nMethod | \nGET | \n\nHeaders | \nDescription | \n\nAuthorization | \nAuthorization token from above preceded by the String \"Bearer\" | \n\nClient-API-Id* | \nYour pVerify client-api-id | \n\n*Note: The Client-API-Id header is required. Header keys are case sensitive.\n\nGetEligibility271 Response\n\nKey | \nValue | \n\nEDI271ANSI | \nANSI String for request or Error Message |"
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/EasyEligibilitySummary:
post:
operationId: easyEligibilitySummary
tags:
- Eligibility
summary: EasyEligibilitySummary
description: "Environment | \nURL | \n\nProduction | \nhttps://api.pverify.com/API/EasyEligibilitySummary | \n\nThe Easy Eligibility Summary call is intended to generate an Eligibility Summary Response in just one step. With EasyEligibilitySummary, simply pass your credentials (no need to generate a token) and the body parameters (specified below) to return an Eligibility Summary Response in just one step.\n\nKey | \nValue | \n\nURL | \nhttps://api.pverify.com/API/EasyEligibilitySummary | \n\nMethod | \nPOST | \n\nHeader | \nDescription | \n\nClient-API-Id | \npVerify client-api-id | \n\nClient-Secret | \npVerify client-secret | \n\nContent-Type | \napplication/json | \n\nBody | \nSee below | \n\nEasyEligibilitySummary Request Fields\n\nField | \nType | \nUsage | \nDescription | \n\npayerCode | \nString | \nRequired | \nPayer Code | \n\npayerName | \nString | \nOptional | \nPayerName | \n\nProvider_LastName | \nString | \nRequired | \nProvider last name | \n\nProvider_NPI | \nString | \nRequired | \nProvider NPI | \n\nProvider_PIN | \nString | \nConditional | \nProvider PIN | \n\nProvider_TaxId | \nString | \nConditional | \nProvider TaxId | \n\nPatient_First | \nString | \nConditional | \nPatient First Name | \n\nPatient_DOB | \nString | \nConditional | \nPatient Date of Birth (in format MM-DD-YYYY) | \n\nPatient_Last | \nString | \nConditional | \nPatient Last Name | \n\nmemberID | \nString | \nConditional | \nMember ID | \n\nDate_Of_Service | \nString | \nRequired | \nDate of Service (in format MM-DD-YYYY) | \n\nDate_Of_Service_To | \nString | \nOptional | \nDate of Service To (in format MM-DD-YYYY). Default date is Date of Service Start date | \n\nreferenceId | \nString | \nOptional | \nPatient MRN or account Number | \n\nLocation | \nString | \nOptional | \nLocation is the practice location. Note by setting this, you will lock the patient to one location, so that users that login in via our portal who are not authorized to see that location will not see the patient. | \n\nPracticeTypeCode | \nString | \nOptional | \nPlease consult Practice Type Code table - sets which practice type to use, i.e. 12 for physical therapy, which will return an object with PT benefits in the results. If you do not select a practice type, the default for your account will be used. Contact pVerify for more info. | \n\nIncludeTextResponse | \nBoolean | \nOptional | \nBoolean value to determine if text response should be included | \n\nInternalId | \nString | \nOptional | \nNo | \n\nCustomerId | \nString | \nOptional | \nNo | \n\nEasyEligibilitySummary Response Fields\n\nKey | \nType | \nDescription | \n\nRequestID | \nInteger | \nEligibility Transaction ID | \n\nAPIResponseCode | \nString | \n0-Processed,1-Rejected,2-NoFunds,3-Pending,4-New | \n\nAPIResponseMessage | \nString | \nMessage about the transaction | \n\nProcessedWithError | \nBoolean | \ntrue when processed with error by the payer. | \n\nEDIErrorMessage | \nString | \nMessage from Payer about errors | \n\nFollowUpAction | \nString | \nResponse from the Payer | \n\nPossibleResolution | \nString | \nSuggested steps to be performed before resubmitting to resolve the issue. | \n\nPverifyPayerCode | \nString | \npVerify’s Payer Code | \n\nPayerName | \nString | \nPayer Name as defined by pVerify | \n\nVerificationType | \nString | \nVerification Type –Subscriber or dependent | \n\nIsPayerBackOffice | \nString | \nIf it is TRUE-NON EDI Payer, FALSE –EDI Payer | \n\nVerificationStatus | \nString | \nEligibility Transaction Status- Values : Processed, Pending, Rejected | \n\nDOS | \nString | \nDate of service start date – DOS end date | \n\nIs HMO Plan | \nBoolean | \nIf true then Patient has HMO plan | \n\nExceptionNotes | \nString | \nException Notes if any. If response demographic info is not matched with that of Request | \n\nAddtionalInfo | \nString | \nIf there is any other info | \n\nLocation | \nString | \nLocation in which trans ran | \n\nReferrenceId | \nString | \nReferencid passed in request | \n\nResultPracticeType | \nString | \nPractice type Name | \n\nAreAllSTCsProcessed* | \nBoolean | \nTrue when all service codes are processed by payer else false, This is helpful to determine to whether transaction needs to be reverify or not. | \n\nSTCsStatusMessage* | \nString | \nContains message when AreAllSTCsProcessed=false. Message contains list of not processed service codes | \n\nIsProviderInNetwork | \nBoolean | \nIf true then Provider is InNetwork. Based on Provider Payer Settings* Null, if NO Provider Payer Settings* (*Requires set up in Premium Portal) | \n\nRecursiveRequestId | \nInteger | \nRequestID of secondary lookup for MCA | \n\nRecursiveAPIResponseCode | \nString | \n0-Processed,1-Rejected, Status of Recursive Inquiry. | \n\nRecursiveAPIResponseMessage | \nString | \nMessage about the Recursive transaction. | \n\nInternalId | \nString | \nField from customer with their InternalId | \n\nCustomerId | \nString | \nField from customer with their CustomerId | \n\nNotes | \nString | \n | \n\nDemographicInfo | \nObject | \nIt contains the subscriber info or dependent info . | \n\nServiceDetails | \nObject | \nIt contains all Service type details info | \n\nPreventiveServices | \nObject | \nContains Preventive codes details | \n\nOtherPayerInfo | \nObject | \nIt contains Other Payer info. It is null then there is no payer change. | \n\nPlanCoverageSummary | \nobject | \nIt contains Plan realted info. | \n\nPCPAuthInfoSummary | \nObject | \nIt contains PCP auth info. | \n\nHBPC_Deductible_OOP_Summary | \nObject | \nIt contains Deductible and OOP in from Health benefit Plan Coverage service type .It is null for Medicare Payer Inquiries. | \n\nMedicareInfoSummary | \nObject | \nIt contains Medicare info summary. It is null for other payers and other summary details are empty for Medicare payer transaction. | \n\nMiscellaneousInfoSummary | \nObject | \n | \n\nSpecialistOfficeSummary | \nPracticeTypeSummary | \nIt contains Specialist Consultation specific Summary (Co-Pay,Co-ins,Ded,OOP) and exclusive values of practice type . | \n\nDiagnosticLabSummary | \nPracticeTypeSummary | \nIt contains Diagnostic Lab specific Summary | \n\nSurgicalSummary | \nPracticeTypeSummary | \nIt contains Surgical specific Summary | \n\nASC_FacilitySummary | \nPracticeT"
requestBody:
required: true
content:
application/json:
schema:
type: object
properties:
payerCode:
type: string
example: '00001'
payerName:
type: string
example: Aetna
Provider_LastName:
type: string
example: SAM MD
Provider_NPI:
type: string
example: '1234567890'
Provider_PIN:
type: string
example: '00000'
Patient_First:
type: string
example: John
Patient_DOB:
type: string
example: 10/02/2010
Patient_Last:
type: string
example: Deo
memberID:
type: string
example: 123456789A
Date_Of_Service:
type: string
example: 07/17/2020
referenceId:
type: string
Location:
type: string
PracticeTypeCode:
type: string
example: '18'
IncludeTextResponse:
type: boolean
example: false
InternalId:
type: string
CustomerID:
type: string
example:
payerCode: '00001'
payerName: Aetna
Provider_LastName: SAM MD
Provider_NPI: '1234567890'
Provider_PIN: '00000'
Patient_First: John
Patient_DOB: 10/02/2010
Patient_Last: Deo
memberID: 123456789A
Date_Of_Service: 07/17/2020
referenceId: ''
Location: ''
PracticeTypeCode: '18'
IncludeTextResponse: false
InternalId: ''
CustomerID: ''
responses:
'200':
description: OK
security:
- clientApiId: []
clientSecret: []
/API/GetPendingInquiries:
get:
operationId: getPendingInquiries
tags:
- Eligibility
summary: GetPendingInquiries
description: "Environment | \nURL | \n\nProduction | \nhttps://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\nGetPendingInquiries Request\n\nKey | \nValue | \n\nURL | \nhttps://api.pverify.com/API/GetPendingInquiries?DOS=01-01-2018 | \n\nMethod | \nGET | \n\nHeaders | \nDescription | \n\nAuthorization | \nAuthorization token from above preceded by the String \"Bearer\" | \n\nClient-API-Id | \nYour pVerify client-api-id | \n\nURL Parameters | \nDate of Service (format is MM-DD-YYYY) |"
parameters:
- name: DOS
in: query
required: false
schema:
type: string
example: 01-01-2018
responses:
'200':
description: OK
security:
- bearerAuth: []
clientApiId: []
/API/CancelTransaction:
post:
operationId: cancelTransaction
tags:
- Eligibility
summary: CancelTransaction
description: "Environment | \nURL | \n\nProduction | \nhttps://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\nCancelTransaction Request\n\nKey | \nValue | \n\nURL | \nhttps://api.pverify.com/API/CancelTransaction | \n\nMethod | \nPOST | \n\nHeaders | \nDescription | \n\nAuthorization | \nAuthorization token from above preceded by the String \"Bearer\" | \n\nClient-API-Id* | \npVerify client-api-id | \n\nContent-Type | \napplication/json | \n\nBody | \nDescription | \n\ntransactionId | \nTransaction ID for transaction you wish to cancel | \n\n*Note: The Client-API-Id is required in header. Header keys are case sensitive."
requestBody:
required: true
content:
application/json:
schema:
type: object
properties:
transactionId:
type: integer
example: 12345455
example:
transactionId: 12345455
responses:
'200':
description: OK
security:
- bearerAuth: []
clientApiId: []
/Report/EligibilityPDFReport/{requestId}:
get:
operationId: getEligibilityPdfReport
tags:
- Eligibility
summary: EligibilityPDFReport
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:
- clientApiId: []
clientSecret: []
/API/GetEligibilityDetailsURL/{requestId}:
get:
operationId: getEligibilityDetailsUrl
tags:
- Eligibility
summary: Details URL
description: "Environment | \nURL | \n\nTest | \n/API/GetEligibilityDetailsURL/{id} | \n\nProduction | \n/API/GetEligibilityDetailsURL/{id} | \n\nThis GET method will return details URL with Eligibility Request ID as a parameter.\n\nGetEligibilityDetailsURL Request\n\nKey | \nValue | \n\nURL | \n/API/GetEligibilityDetailsURL/{id} | \n\nMethod | \nGET | \n\nHeaders | \nDescription | \n\nAuthorization | \nAuthorization token from above preceded by the String \"Bearer\" | \n\nClient-API-Id* | \nYour pVerify client-api-id | \n\nContent-Type | \napplication/json | \n\n*Note: The Client-API-Id header is required. Header keys are case sensitive.\n\nGetEligibilityDetailsURL Resposne\n\nKey | \nValue | \n\nisDetailsURLGenerated | \nTrue or false | \n\nurl | \nstring URL | \n\nerrorMessage | \nMessage when isDetailsURLGenerated is false | \n\nJSON Response\n\n{\n\n\"isDetailsURLGenerated\": true,\n\n\"url\": \"https://premium.pverify.com/Details\",\n\n\"errorMessage\": null\n\n}"
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.