pVerify Insurance Discovery API

openapi: 3.2.0
info:
  title: pVerify Insurance Discovery API
  description: pVerify Insurance Discovery 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: Insurance Discovery
paths:
  /api/InsuranceDiscovery:
    post:
      operationId: insuranceDiscovery
      tags:
      - Insurance Discovery
      summary: InsuranceDiscovery
      description: "Environment | \nURL | \n\nTest | \nhttps://testapi.pverify.com/API/InsuranceDiscovery | \n\nProduction | \nhttps://api.pverify.com/API/InsuranceDiscovery | \n\npVerify’s Insurance Discovery allows Hospitals and Providers to find a patient’s insurance coverage to collect potentially millions from insurance companies, allow prompt claim submission, increase patient payment collection, and drastically decrease Account Receivables.\n\nPatient StatesTo run insurance discovery a patient state or patient state ID is required. As part of the setup, pVerify will work with you to create Patient States.\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\nHeaders\n\nKey | \nValue | \n\nURL | \nhttps://api.pverify.com/API/InsuranceDiscovery | \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\nInsuranceDiscovery Request Fields\n\nProperty Name | \nData Type | \nUsage | \nDescription | \n\npatientStateId | \nInteger | \nConditional | \nPlease get it from pverify Team. Either patientSateId or patientState is required. | \n\npatientState | \nString | \nConditional | \nPlease get it from pverify Team. Either patientSateId or patientState is required. | \n\npatientFirstName | \nString | \nRequired | \nFirst Name of patient required for inquiry | \n\npatientLastName | \nString | \nRequired | \nLast Name of patient required for inquiry | \n\npatientDOB | \nString | \nRequired | \nRequired for self-inquiry for better matching result. (Expected format: MM/dd/YYYY ie 01/01/2000) | \n\npatientSSN | \nString | \nConditional | \nSSN of Patient(To MBI lookup) | \n\npatientGender | \nString | \nConditional | \nGender will be mandatory for Medicaid patients | \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\nreferenceId | \nString | \nOptional | \nPatient MRN or account Number | \n\nNotes | \nString | \nOptional | \nany free-text related patient | \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\nverifyMedicare | \nBoolean | \nOptional | \nDefault is false. If true, then Medicare transaction will takes place when the patient's age is >30 years. | \n\npatientHasDisability | \nBoolean | \nOptional | \nDefault is false. If true, then Medicare transaction will takes place. | \n\nInsuranceDiscovery Response Fields\n\nKey | \nType | \nDescription | \n\nRequestID | \nInteger | \nEligibility Transaction ID | \n\nAPIResponseCode | \nString | \n0-Processed,1-Rejected,2-NoFunds,3-Pending | \n\nAPIResponseMessage | \nString | \nMessage about the transaction | \n\nEDIErrorMessage | \nString | \nMessage from Payer about errors | \n\nPayerName | \nString | \nPayer Name as defined by pVerify | \n\nPverifyPayerCode | \nString | \nPverify Payer Code | \n\nClientPayerName | \nString | \nIt contains client practice payer map name to the pverify payer. | \n\nVerificationType | \nString | \nVerification Type –Subscriber or dependent | \n\nDOS | \nString | \nDate of service start date – DOS end date | \n\nIsHMOPlan | \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\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\nSpecialistOfficeSummary | \nPracticeTypeSummary | \nIt contains Specialist Consultation specific Summary (Co-Pay,Co-ins,Ded,OOP) and exclusive values of practice type . | \n\nComboPayerResponses | \nArray of Object | \nIt conatins Combo Group payer responses.. This response has been appended with Address,DOB,FullName,MemberId. | \n\nComboPayerResponses.Address | \nString | \nIt contains Address | \n\nComboPayerResponses.DOB | \nString | \nIt contains DOB | \n\nComboPayerResponses.FullName | \nString | \nIt contains FullName | \n\nComboPayerResponses.MemberId | \nString | \nIt contains MemberId | \n\nComboPayerResponses.City | \nString | \nIt contains City | \n\nComboPayerResponses.State | \nString | \nIt contains State | "
      requestBody:
        required: true
        content:
          application/json:
            schema:
              type: object
              properties:
                doS_EndDate:
                  type: string
                  example: 04/28/2023
                doS_StartDate:
                  type: string
                  example: 04/28/2023
                patientStateId:
                  type: integer
                  example: 10
                patientState:
                  type: string
                patientSSN:
                  type: string
                patientLastName:
                  type: string
                  example: TEST
                patientFirstName:
                  type: string
                  example: TEST
                patientDOB:
                  type: string
                  example: 01/01/1950
                patientGender:
                  type: string
                  example: M
                location:
                  type: string
                  example: CA
                notes:
                  type: string
                verifyMedicare:
                  type: boolean
                  example: false
                patientHasDisability:
                  type: boolean
                  example: false
            example:
              doS_EndDate: 04/28/2023
              doS_StartDate: 04/28/2023
              patientStateId: 10
              patientState: ''
              patientSSN: ''
              patientLastName: TEST
              patientFirstName: TEST
              patientDOB: 01/01/1950
              patientGender: M
              location: CA
              notes: ''
              verifyMedicare: false
              patientHasDisability: false
      responses:
        '200':
          description: OK
      security:
      - bearerAuth: []
        clientApiId: []
  /api/GetInusuranceDiscoverySummaryResponse/{requestId}:
    get:
      operationId: getInsuranceDiscoverySummaryResponse
      tags:
      - Insurance Discovery
      summary: InsuranceDiscovery GET
      description: "Environment | \nURL | \n\nTest | \nhttps://testapi.pverify.com/API/GetInusuranceDiscoverySummaryResponse/{id} | \n\nProduction | \nhttps://api.pverify.com/API/GetInusuranceDiscoverySummaryResponse/{id} | \n\nGetInusuranceDiscoverySummaryResponse returns the response from the InsuranceDiscovery POST call using a unique request id provided in the InsuranceDiscovery response.\n\nHeaders\n\nKey | \nValue | \n\nURL | \nhttps://api.pverify.com/API/GetInusuranceDiscoverySummaryResponse/{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\nClient-API-Id | \nAPI ID provided by pVerify | \n\nContent-Type | \napplication/json | \n\nURL Parameters | \nRequestId returned in InsuranceDiscovery response | \n\n*Note: The Client-API-Id header is required. Header keys are case sensitive.\n\nGetInusuranceDiscoverySummaryResponse Response Fields\n\nSee InsuranceDiscovery 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/GetInsuranceDiscoveryDetailsURL/{requestId}:
    get:
      operationId: getInsuranceDiscoveryDetailsUrl
      tags:
      - Insurance Discovery
      summary: ID Details URL
      description: "Environment | \nURL | \n\nTest | \n/API/GetInsuranceDiscoveryDetailsURL/{id} | \n\nProduction | \n/API/GetInsuranceDiscoveryDetailsURL/{id} | \n\nThis GET method will return details URL with Insurance Discovery Request ID as a parameter.\n\nGetInsuranceDiscoveryDetailsURL Request\n\nKey | \nValue | \n\nURL | \n/API/GetInsuranceDiscoveryDetailsURL/{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\nGetInsuranceDiscoveryDetailsURL 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: []
  /PDFReport/InsuranceDiscovery/{id}:
    get:
      operationId: getInsuranceDiscoveryReport
      tags:
      - Insurance Discovery
      summary: Insurance Discovery Report
      description: "This returns a PDF report of the Insurance Discovery request.\n\nNote two things:\n\nThe endpoint is premium.pverify.com\n\nAuthentication token is not used, instead pass your API ID and Secret. \n\nReplace {id} with the requestid you receive from the Insurance Discovery request."
      parameters:
      - name: id
        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: []
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.