pVerify Insurance Discovery API

# Derived from pVerify's published Postman collection: https://postman.pverify.com/
# method: derived  generated: 2026-08-14
openapi: 3.0.3
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 | \n\
        Usage | \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 | \n\
        Conditional | \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 | \n\
        String | \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 | \n\
        Object | \nIt contains all Service type details info | \n\nPreventiveServices | \nObject | \n\
        Contains 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\n\
        Production | \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.