pVerify

pVerify provides real-time healthcare insurance eligibility verification and revenue-cycle APIs. Its RESTful API at https://api.pverify.com exchanges EDI 270/271 eligibility transactions, returns plan and benefit summaries, checks claim status (276/277), lists supported payers, and estimates patient financial responsibility, secured with OAuth2 bearer tokens.

6 APIs 0 Features

HealthcareInsuranceEligibilityClaimsEDI270/271

APIs

pVerify Eligibility Inquiry API

Real-time 270/271 eligibility inquiry that posts a full benefit request to a payer and returns the detailed 271 response, with asynchronous retrieval (GetEligibilityResponse), p...

pVerify Eligibility Summary API

Posts a single real-time eligibility request and returns a condensed, practice-type-specific summary of plan, coverage, copay, coinsurance, deductible, and out-of-pocket benefits.

pVerify Batch Eligibility API

Submits many eligibility verifications in a single batch for asynchronous processing and later retrieval of completed results.

pVerify Claim Status API

Real-time 276/277 claim status inquiry returning the current processing state, dates, and amounts for a submitted claim direct from the payer.

pVerify Payers API

Returns the current pVerify payer list with payerCode, payerName, and capability flags (isActive, isSupportingEligibility, isSupportingClaims, isEDIPayer) for mapping requests t...

pVerify Estimation API

Patient cost estimation that combines real-time benefits with contracted/fee data to estimate patient financial responsibility for planned services.

Collections

pVerify API

OPEN

Pricing Plans

Pverify Plans Pricing

2 plans

PLANS

Rate Limits

Pverify Rate Limits

4 limits

RATE LIMITS

FinOps

Pverify Finops

FINOPS

Resources

👥

GitHubOrganization

Sources

opencollection: 1.0.0
info:
  name: pVerify API
  version: '1.0'
request:
  auth:
    type: bearer
    token: '{{bearerToken}}'
items:
- info:
    name: Authentication
    type: folder
  items:
  - info:
      name: Generate an OAuth2 access token
      type: http
    http:
      method: POST
      url: https://api.pverify.com/Token
      body:
        type: urlencoded
        data: Client_Id=<string>&Client_Secret=<string>&grant_type=client_credentials
    docs: Exchanges Client_Id and Client_Secret for an OAuth2 bearer access token using the client_credentials grant.
- info:
    name: Eligibility
    type: folder
  items:
  - info:
      name: Real-time eligibility summary
      type: http
    http:
      method: POST
      url: https://api.pverify.com/API/EligibilitySummary
      body:
        type: json
        data: '{}'
    docs: Posts a single real-time eligibility request and returns a condensed, practice-type-specific benefit summary.
  - info:
      name: Real-time 270/271 eligibility inquiry
      type: http
    http:
      method: POST
      url: https://api.pverify.com/API/EligibilityInquiry
      body:
        type: json
        data: '{}'
    docs: Posts a full 270 request and returns the detailed 271 response with a unique requestId.
  - info:
      name: Retrieve a prior eligibility response
      type: http
    http:
      method: GET
      url: https://api.pverify.com/API/GetEligibilityResponse?requestId=<string>
    docs: Returns the same response produced by an EligibilityInquiry POST using its requestId.
  - info:
      name: List pending inquiries
      type: http
    http:
      method: GET
      url: https://api.pverify.com/API/GetPendingInquiries
    docs: Returns the list of eligibility inquiries still in a Pending state.
  - info:
      name: Cancel a pending transaction
      type: http
    http:
      method: POST
      url: https://api.pverify.com/API/CancelTransaction
      body:
        type: json
        data: '{}'
    docs: Sets a pending inquiry's state to Cancel and removes it from the queue.
- info:
    name: Batch
    type: folder
  items:
  - info:
      name: Submit a batch of eligibility verifications
      type: http
    http:
      method: POST
      url: https://api.pverify.com/API/BatchEligibility
      body:
        type: json
        data: '{}'
    docs: Submits multiple eligibility verifications in a single request for asynchronous processing.
- info:
    name: Claim Status
    type: folder
  items:
  - info:
      name: Real-time 276/277 claim status
      type: http
    http:
      method: POST
      url: https://api.pverify.com/API/ClaimStatus
      body:
        type: json
        data: '{}'
    docs: Posts a 276 claim status inquiry and returns the current 277 state, dates, and amounts for a claim.
- info:
    name: Payers
    type: folder
  items:
  - info:
      name: List supported payers
      type: http
    http:
      method: GET
      url: https://api.pverify.com/API/Payers
    docs: Returns the current pVerify payer list with codes, names, and capability flags.
- info:
    name: Estimation
    type: folder
  items:
  - info:
      name: Patient cost estimation
      type: http
    http:
      method: POST
      url: https://api.pverify.com/API/EstimationInquiry
      body:
        type: json
        data: '{}'
    docs: Combines real-time benefits with contracted/fee data to estimate patient financial responsibility.