slug: pverify
provider: pVerify
generated_by: planning/capability-mapping/scripts/classify_capabilities.py
model: claude-opus-5
frame:
- Healthcare Providers
min_confidence: 0.7
capability_model:
  source: https://github.com/vincentmakes/turbo-ea-capabilities
  license: CC-BY-4.0
  attribution: Turbo EA Capabilities by Vincent Verdet — Turbo EA, https://github.com/vincentmakes/turbo-ea-capabilities,
    CC BY 4.0
  notice: NOTICE
edge_count: 6
edges:
- tag: Eligibility
  spec_file: pverify-eligibility-api-openapi.yml
  capability_id: BC-2800.30
  capability_id_l1: BC-2800
  capability_name: Eligibility & Benefits Verification
  confidence: 0.95
  evidence: GET /API/GetEligibility271/{requestId}  getEligibility271; POST /api/EligibilitySummary
  reason: X12 270/271 eligibility transactions returning parsed benefit summaries is plainly verification
    of insurance coverage and benefits before service.
- tag: Dental Eligibility
  spec_file: pverify-dental-eligibility-api-openapi.yml
  capability_id: BC-2800.30
  capability_id_l1: BC-2800
  capability_name: Eligibility & Benefits Verification
  confidence: 0.9
  evidence: POST /api/DentalEligibilityBenefitSummary  dentalEligibilityBenefitSummary
  reason: Operations return insurance eligibility and benefit summaries for dental payers — directly Eligibility
    & Benefits Verification prior to service delivery.
- tag: Claim Status
  spec_file: pverify-claim-status-api-openapi.yml
  capability_id: BC-2870.30
  capability_id_l1: BC-2870
  capability_name: Claim Production & Submission
  confidence: 0.85
  evidence: 'POST /API/ClaimStatusInquiry  claimStatusInquiry ... vendor: ''runs 276/277 claim status
    inquiries'''
  reason: X12 276/277 claim status inquiry against payers matches Claim Production & Submission, which
    explicitly covers 'status tracking of claims to payers'.
- tag: Estimation
  spec_file: pverify-estimation-api-openapi.yml
  capability_id: BC-2800.40
  capability_id_l1: BC-2800
  capability_name: Financial Counselling & Estimation
  confidence: 0.85
  evidence: pVerify Patient Cost Estimator API ... POST /api/EstimateCalculation  estimateCalculation
  reason: Patient cost estimation calculation maps to Financial Counselling & Estimation (out-of-pocket
    estimation) in patient access.
- tag: Insurance Discovery
  spec_file: pverify-insurance-discovery-api-openapi.yml
  capability_id: BC-2800.30
  capability_id_l1: BC-2800
  capability_name: Eligibility & Benefits Verification
  confidence: 0.8
  evidence: 'POST /api/InsuranceDiscovery ... vendor: ''discovers unknown active coverage for self-pay
    patients'''
  reason: Discovery of active insurance coverage for patients presenting as self-pay is coverage/benefits
    verification within patient access; could alternatively sit in revenue cycle, hence 0.8.
- tag: CGX Widget
  spec_file: pverify-cgx-widget-api-openapi.yml
  capability_id: BC-2800
  capability_id_l1: BC-2800
  capability_name: Patient Access Management
  confidence: 0.75
  evidence: POST /api/CGXInquiry  cgxInquiry  CGXInquiry - Estimates and Eligibility Combo
  reason: The inquiry combines insurance eligibility verification with patient cost estimates, both pre-encounter
    patient-access activities. Because it spans both eligibility verification and financial estimation,
    only the L1 is asserted.