Last Updated 03/01/2026
\npVerify's Real-Time Exchange System facilitates the secure exchange of health care Eligibility and related transactions, supporting one-to-one real-time transactions. One-to-one real-time transactions require customers to post a request, via REST to a designated URL address. Once a request is received by the Service an immediate response is sent for each request posted. Note that first a token must be generated using Oauth2.
\nThe production URL is api.pverify.com
For example, the token call is: https://api.pverify.com/Token
The EligibilitySummary call is: https://api.pverify.com/API/EligibilitySummary
We now have NuGet packages for .NET coding. Download from Visual Studio today from NuGet - pVerify.Apis
\nClick here to download the NuGet package from GitHub.
\nClick here to download a sample project showing the use of the Nuget package. (C#)
\nFor the EligibilityInquiry, GetEligibilityResponse, and EligibilitySummary calls, we can return Medicare preventative service information. You can either populate the preventative service codes in the request or as a one time set up, use our portal at Premium.Pverify.com -> Admin/Profile -> Settings -> Medicare HCPCS Codes. These settings in the UI will be used if the request HCPCS codes are blank.
\nFor example you can add this to the request:
\n\"HCPCSCodes\": [\n\"G0297\"\n],\n\nAnd it will return the code to the right under ServiceTypeDetailInfo - for this patient they were eligible for this code on 2/5/2015.
\n\"ServicesTypes\": [{\n \"ServiceTypeName\": \"Preventive Services\",\n \"ServiceTypeSections\": [{\n \"Label\": \"HCPCS|G0104\",\n \"ServiceParameters\": [{\n \"Key\": \"Professional Eligible Date\",\n \"Value\": \"04/01/2014\",\n \"Message\": null,\n \"OtherInfo\": null\n }, {\n \"Key\": \"Technical Eligible Date\",\n \"Value\": \"04/01/2014\",\n \"Message\": null,\n \"OtherInfo\": null\n }, {\n \"Key\": \"Visit Co-Insurance\",\n \"Value\": \"0%\",\n \"Message\": null,\n \"OtherInfo\": null\n }, {\n \"Key\": \"Calendar Year Deductible\",\n \"Value\": \"$0.00\",\n \"Message\": null,\n \"OtherInfo\": null\n }]\n }, {\n \"Label\": \"HCPCS|G0105\",\n \"ServiceParameters\": [{\n \"Key\": \"Professional Eligible Date\",\n \"Value\": \"04/01/2014\",\n \"Message\": null,\n \"OtherInfo\": null\n }, {\n \"Key\": \"Technical Eligible Date\",\n \"Value\": \"04/01/2014\",\n \"Message\": null,\n \"OtherInfo\": null\n }, {\n \"Key\": \"Visit Co-Insurance\",\n \"Value\": \"0%\",\n \"Message\": null,\n \"OtherInfo\": null\n }, {\n \"Key\": \"Calendar Year Deductible\",\n \"Value\": \"$0.00\",\n \"Message\": null,\n \"OtherInfo\": null\n }]\n }, {\n \"Label\": \"HCPCS|G0106\",\n \"ServiceParameters\": [{\n \"Key\": \"Professional Eligible Date\",\n \"Value\": \"04/01/2014\",\n \"Message\": null,\n \"OtherInfo\": null\n }, {\n \"Key\": \"Technical Eligible Date\",\n \"Value\": \"04/01/2014\",\n \"Message\": null,\n \"OtherInfo\": null\n }, {\n \"Key\": \"Calendar Year Deductible\",\n \"Value\": \"$0.00\",\n \"Message\": null,\n \"OtherInfo\": null\n }]\n }, {\n \"Label\": \"HCPCS|G0120\",\n \"ServiceParameters\": [{\n \"Key\": \"Professional Eligible Date\",\n \"Value\": \"04/01/2014\",\n \"Message\": null,\n \"OtherInfo\": null\n }, {\n \"Key\": \"Technical Eligible Date\",\n \"Value\": \"04/01/2014\",\n \"Message\": null,\n \"OtherInfo\": null\n }, {\n \"Key\": \"Calendar Year Deductible\",\n \"Value\": \"$0.00\",\n \"Message\": null,\n \"OtherInfo\": null\n }]\n }, {\n \"Label\": \"HCPCS|G0121\",\n \"ServiceParameters\": [{\n \"Key\": \"Professional Eligible Date\",\n \"Value\": \"04/01/2014\",\n \"Message\": null,\n \"OtherInfo\": null\n }, {\n \"Key\": \"Technical Eligible Date\",\n \"Value\": \"04/01/2014\",\n \"Message\": null,\n \"OtherInfo\": null\n }, {\n \"Key\": \"Visit Co-Insurance\",\n \"Value\": \"0%\",\n \"Message\": null,\n \"OtherInfo\": null\n }, {\n \"Key\": \"Calendar Year Deductible\",\n \"Value\": \"$0.00\",\n \"Message\": null,\n \"OtherInfo\": null\n }]\n }, {\n \"Label\": \"HCPCS|81528\",\n \"ServiceParameters\": [{\n \"Key\": \"Technical Eligible Date\",\n \"Value\": \"10/09/2014\",\n \"Message\": null,\n \"OtherInfo\": null\n }, {\n \"Key\": \"Visit Co-Insurance\",\n \"Value\": \"0%\",\n \"Message\": null,\n \"OtherInfo\": null\n }, {\n \"Key\": \"Calendar Year Deductible\",\n \"Value\": \"$0.00\",\n \"Message\": null,\n \"OtherInfo\": null\n }]\n }]\n }\n\n\"PreventiveServices\": [{\n \"ProcedureCode\": \"HCPCS|G0444\",\n \"ProcedureName\": \"Annual Depression Screening\",\n \"TechnicalEligibleDate\": \"10/14/2011\",\n \"ProfessionalEligibleDate\": \"10/14/2011\",\n \"Benefits\": [{\n \"EligibilityOrBenefit\": \"Deductible\",\n \"InsuranceType\": \"Medicare Part B\",\n \"Date\": [{\n \"Date\": \"01/18/2021\",\n \"Type\": \"Benefit\"\n }],\n \"TimePeriodQualifier\": \"Calendar Year\",\n \"MonetaryAmount\": \"$0.00\",\n \"Percent\": null,\n \"UsedDate\": null,\n \"IdentificationCode\": null,\n \"IdentificationType\": null\n }, {\n \"EligibilityOrBenefit\": \"Co-Insurance\",\n \"InsuranceType\": \"Medicare Part B\",\n \"Date\": [{\n \"Date\": \"01/18/2021\",\n \"Type\": \"Benefit\"\n }],\n \"TimePeriodQualifier\": \"Visit\",\n \"MonetaryAmount\": null,\n \"Percent\": \"0%\",\n \"UsedDate\": null,\n \"IdentificationCode\": null,\n \"IdentificationType\": null\n }]\n}, {\n \"ProcedureCode\": \"HCPCS|G0499\",\n \"ProcedureName\": \"Hepatitis B Virus (HCV) in Adults Screening\",\n \"TechnicalEligibleDate\": \"09/28/2016\",\n \"ProfessionalEligibleDate\": \"09/28/2016\",\n \"Benefits\": [{\n \"EligibilityOrBenefit\": \"Deductible\",\n \"InsuranceType\": \"Medicare Part B\",\n \"Date\": [{\n \"Date\": \"01/18/2021\",\n \"Type\": \"Benefit\"\n }],\n \"TimePeriodQualifier\": \"Calendar Year\",\n \"MonetaryAmount\": \"$0.00\",\n \"Percent\": null,\n \"UsedDate\": null,\n \"IdentificationCode\": null,\n \"IdentificationType\": null\n }, {\n \"EligibilityOrBenefit\": \"Co-Insurance\",\n \"InsuranceType\": \"Medicare Part B\",\n \"Date\": [{\n \"Date\": \"01/18/2021\",\n \"Type\": \"Benefit\"\n }],\n \"TimePeriodQualifier\": \"Visit\",\n \"MonetaryAmount\": null,\n \"Percent\": \"0%\",\n \"UsedDate\": null,\n \"IdentificationCode\": null,\n \"IdentificationType\": null\n }]\n}, {\n \"ProcedureCode\": \"HCPCS|84478\",\n \"ProcedureName\": \"Cardiovascular Disease Screening (CARD)\",\n \"TechnicalEligibleDate\": \"01/01/2005\",\n \"ProfessionalEligibleDate\": \"01/01/2005\",\n \"Benefits\": [{\n \"EligibilityOrBenefit\": \"Deductible\",\n \"InsuranceType\": \"Medicare Part B\",\n \"Date\": [{\n \"Date\": \"01/18/2021\",\n \"Type\": \"Benefit\"\n }],\n \"TimePeriodQualifier\": \"Calendar Year\",\n \"MonetaryAmount\": \"$0.00\",\n \"Percent\": null,\n \"UsedDate\": null,\n \"IdentificationCode\": null,\n \"IdentificationType\": null\n }, {\n \"EligibilityOrBenefit\": \"Co-Insurance\",\n \"InsuranceType\": \"Medicare Part B\",\n \"Date\": [{\n \"Date\": \"01/18/2021\",\n \"Type\": \"Benefit\"\n }],\n \"TimePeriodQualifier\": \"Visit\",\n \"MonetaryAmount\": null,\n \"Percent\": \"0%\",\n \"UsedDate\": null,\n \"IdentificationCode\": null,\n \"IdentificationType\": null\n }]\n}, {\n \"ProcedureCode\": \"HCPCS|83718\",\n \"ProcedureName\": \"Cardiovascular Disease Screening (CARD)\",\n \"TechnicalEligibleDate\": \"01/01/2005\",\n \"ProfessionalEligibleDate\": \"01/01/2005\",\n \"Benefits\": [{\n \"EligibilityOrBenefit\": \"Deductible\",\n \"InsuranceType\": \"Medicare Part B\",\n \"Date\": [{\n \"Date\": \"01/18/2021\",\n \"Type\": \"Benefit\"\n }],\n \"TimePeriodQualifier\": \"Calendar Year\",\n \"MonetaryAmount\": \"$0.00\",\n \"Percent\": null,\n \"UsedDate\": null,\n \"IdentificationCode\": null,\n \"IdentificationType\": null\n }, {\n \"EligibilityOrBenefit\": \"Co-Insurance\",\n \"InsuranceType\": \"Medicare Part B\",\n \"Date\": [{\n \"Date\": \"01/18/2021\",\n \"Type\": \"Benefit\"\n }],\n \"TimePeriodQualifier\": \"Visit\",\n \"MonetaryAmount\": null,\n \"Percent\": \"0%\",\n \"UsedDate\": null,\n \"IdentificationCode\": null,\n \"IdentificationType\": null\n }]\n}, {\n \"ProcedureCode\": \"HCPCS|82947\",\n \"ProcedureName\": \"Diabetes Screening Tests (DIAB)\",\n \"TechnicalEligibleDate\": \"01/01/2005\",\n \"ProfessionalEligibleDate\": \"01/01/2005\",\n \"Benefits\": [{\n \"EligibilityOrBenefit\": \"Deductible\",\n \"InsuranceType\": \"Medicare Part B\",\n \"Date\": [{\n \"Date\": \"01/18/2021\",\n \"Type\": \"Benefit\"\n }],\n \"TimePeriodQualifier\": \"Calendar Year\",\n \"MonetaryAmount\": \"$0.00\",\n \"Percent\": null,\n \"UsedDate\": null,\n \"IdentificationCode\": null,\n \"IdentificationType\": null\n }, {\n \"EligibilityOrBenefit\": \"Co-Insurance\",\n \"InsuranceType\": \"Medicare Part B\",\n \"Date\": [{\n \"Date\": \"01/18/2021\",\n \"Type\": \"Benefit\"\n }],\n \"TimePeriodQualifier\": \"Visit\",\n \"MonetaryAmount\": null,\n \"Percent\": \"0%\",\n \"UsedDate\": null,\n \"IdentificationCode\": null,\n \"IdentificationType\": null\n }]\n}, {\n \"ProcedureCode\": \"HCPCS|G0446\",\n \"ProcedureName\": \"Intensive Behavioral Theropy (IBT) for Cardiovascular Disease (CVD)\",\n \"TechnicalEligibleDate\": \"11/08/2011\",\n \"ProfessionalEligibleDate\": \"11/08/2011\",\n \"Benefits\": [{\n \"EligibilityOrBenefit\": \"Deductible\",\n \"InsuranceType\": \"Medicare Part B\",\n \"Date\": [{\n \"Date\": \"01/18/2021\",\n \"Type\": \"Benefit\"\n }],\n \"TimePeriodQualifier\": \"Calendar Year\",\n \"MonetaryAmount\": \"$0.00\",\n \"Percent\": null,\n \"UsedDate\": null,\n \"IdentificationCode\": null,\n \"IdentificationType\": null\n }, {\n \"EligibilityOrBenefit\": \"Co-Insurance\",\n \"InsuranceType\": \"Medicare Part B\",\n \"Date\": [{\n \"Date\": \"01/18/2021\",\n \"Type\": \"Benefit\"\n }],\n \"TimePeriodQualifier\": \"Visit\",\n \"MonetaryAmount\": null,\n \"Percent\": \"0%\",\n \"UsedDate\": null,\n \"IdentificationCode\": null,\n \"IdentificationType\": null\n }]\n}, {\n \"ProcedureCode\": \"HCPCS|76706\",\n \"ProcedureName\": \"Ultrasound Screening for Abdominal Aortic Aneurysm (AAA)\",\n \"TechnicalEligibleDate\": \"07/01/2007\",\n \"ProfessionalEligibleDate\": \"07/01/2007\",\n \"Benefits\": [{\n \"EligibilityOrBenefit\": \"Deductible\",\n \"InsuranceType\": \"Medicare Part B\",\n \"Date\": [{\n \"Date\": \"01/18/2021\",\n \"Type\": \"Benefit\"\n }],\n \"TimePeriodQualifier\": \"Calendar Year\",\n \"MonetaryAmount\": \"$0.00\",\n \"Percent\": null,\n \"UsedDate\": null,\n \"IdentificationCode\": null,\n \"IdentificationType\": null\n }, {\n \"EligibilityOrBenefit\": \"Co-Insurance\",\n \"InsuranceType\": \"Medicare Part B\",\n \"Date\": [{\n \"Date\": \"01/18/2021\",\n \"Type\": \"Benefit\"\n }],\n \"TimePeriodQualifier\": \"Visit\",\n \"MonetaryAmount\": null,\n \"Percent\": \"0%\",\n \"UsedDate\": null,\n \"IdentificationCode\": null,\n \"IdentificationType\": null\n }]\n}, {\n \"ProcedureCode\": \"HCPCS|G0438\",\n \"ProcedureName\": \"Annual Wellness Visit (AMV)\",\n \"TechnicalEligibleDate\": null,\n \"ProfessionalEligibleDate\": \"01/01/2011\",\n \"Benefits\": [{\n \"EligibilityOrBenefit\": \"Deductible\",\n \"InsuranceType\": \"Medicare Part B\",\n \"Date\": [{\n \"Date\": \"01/18/2021\",\n \"Type\": \"Benefit\"\n }],\n \"TimePeriodQualifier\": \"Calendar Year\",\n \"MonetaryAmount\": \"$0.00\",\n \"Percent\": null,\n \"UsedDate\": null,\n \"IdentificationCode\": null,\n \"IdentificationType\": null\n }, {\n \"EligibilityOrBenefit\": \"Co-Insurance\",\n \"InsuranceType\": \"Medicare Part B\",\n \"Date\": [{\n \"Date\": \"01/18/2021\",\n \"Type\": \"Benefit\"\n }],\n \"TimePeriodQualifier\": \"Visit\",\n \"MonetaryAmount\": null,\n \"Percent\": \"0%\",\n \"UsedDate\": null,\n \"IdentificationCode\": null,\n \"IdentificationType\": null\n }]\n}, {\n \"ProcedureCode\": \"HCPCS|G0328\",\n \"ProcedureName\": \"Fecal Occult Blood Test\",\n \"TechnicalEligibleDate\": \"01/01/2004\",\n \"ProfessionalEligibleDate\": \"01/01/2004\",\n \"Benefits\": [{\n \"EligibilityOrBenefit\": \"Deductible\",\n \"InsuranceType\": \"Medicare Part B\",\n \"Date\": [{\n \"Date\": \"01/18/2021\",\n \"Type\": \"Benefit\"\n }],\n \"TimePeriodQualifier\": \"Calendar Year\",\n \"MonetaryAmount\": \"$0.00\",\n \"Percent\": null,\n \"UsedDate\": null,\n \"IdentificationCode\": null,\n \"IdentificationType\": null\n }, {\n \"EligibilityOrBenefit\": \"Co-Insurance\",\n \"InsuranceType\": \"Medicare Part B\",\n \"Date\": [{\n \"Date\": \"01/18/2021\",\n \"Type\": \"Benefit\"\n }],\n \"TimePeriodQualifier\": \"Visit\",\n \"MonetaryAmount\": null,\n \"Percent\": \"0%\",\n \"UsedDate\": null,\n \"IdentificationCode\": null,\n \"IdentificationType\": null\n }]\n}, {\n \"ProcedureCode\": \"HCPCS|G0442\",\n \"ProcedureName\": \"Annual Alcohol Misuse Screening\",\n \"TechnicalEligibleDate\": null,\n \"ProfessionalEligibleDate\": \"10/14/2011\",\n \"Benefits\": [{\n \"EligibilityOrBenefit\": \"Deductible\",\n \"InsuranceType\": \"Medicare Part B\",\n \"Date\": [{\n \"Date\": \"01/18/2021\",\n \"Type\": \"Benefit\"\n }],\n \"TimePeriodQualifier\": \"Calendar Year\",\n \"MonetaryAmount\": \"$0.00\",\n \"Percent\": null,\n \"UsedDate\": null,\n \"IdentificationCode\": null,\n \"IdentificationType\": null\n }, {\n \"EligibilityOrBenefit\": \"Co-Insurance\",\n \"InsuranceType\": \"Medicare Part B\",\n \"Date\": [{\n \"Date\": \"01/18/2021\",\n \"Type\": \"Benefit\"\n }],\n \"TimePeriodQualifier\": \"Visit\",\n \"MonetaryAmount\": null,\n \"Percent\": \"0%\",\n \"UsedDate\": null,\n \"IdentificationCode\": null,\n \"IdentificationType\": null\n }]\n}, {\n \"ProcedureCode\": \"HCPCS|G0105\",\n \"ProcedureName\": \"Colorectal Cancer Screening (COLO)\",\n \"TechnicalEligibleDate\": \"01/01/1998\",\n \"ProfessionalEligibleDate\": \"01/01/1998\",\n \"Benefits\": [{\n \"EligibilityOrBenefit\": \"Deductible\",\n \"InsuranceType\": \"Medicare Part B\",\n \"Date\": [{\n \"Date\": \"01/18/2021\",\n \"Type\": \"Benefit\"\n }],\n \"TimePeriodQualifier\": \"Calendar Year\",\n \"MonetaryAmount\": \"$0.00\",\n \"Percent\": null,\n \"UsedDate\": null,\n \"IdentificationCode\": null,\n \"IdentificationType\": null\n }, {\n \"EligibilityOrBenefit\": \"Co-Insurance\",\n \"InsuranceType\": \"Medicare Part B\",\n \"Date\": [{\n \"Date\": \"01/18/2021\",\n \"Type\": \"Benefit\"\n }],\n \"TimePeriodQualifier\": \"Visit\",\n \"MonetaryAmount\": null,\n \"Percent\": \"0%\",\n \"UsedDate\": null,\n \"IdentificationCode\": null,\n \"IdentificationType\": null\n }]\n}, {\n \"ProcedureCode\": \"HCPCS|82465\",\n \"ProcedureName\": \"Cardiovascular Disease Screening (CARD)\",\n \"TechnicalEligibleDate\": \"01/01/2005\",\n \"ProfessionalEligibleDate\": \"01/01/2005\",\n \"Benefits\": [{\n \"EligibilityOrBenefit\": \"Deductible\",\n \"InsuranceType\": \"Medicare Part B\",\n \"Date\": [{\n \"Date\": \"01/18/2021\",\n \"Type\": \"Benefit\"\n }],\n \"TimePeriodQualifier\": \"Calendar Year\",\n \"MonetaryAmount\": \"$0.00\",\n \"Percent\": null,\n \"UsedDate\": null,\n \"IdentificationCode\": null,\n \"IdentificationType\": null\n }, {\n \"EligibilityOrBenefit\": \"Co-Insurance\",\n \"InsuranceType\": \"Medicare Part B\",\n \"Date\": [{\n \"Date\": \"01/18/2021\",\n \"Type\": \"Benefit\"\n }],\n \"TimePeriodQualifier\": \"Visit\",\n \"MonetaryAmount\": null,\n \"Percent\": \"0%\",\n \"UsedDate\": null,\n \"IdentificationCode\": null,\n \"IdentificationType\": null\n }]\n}, {\n \"ProcedureCode\": \"HCPCS|G0472\",\n \"ProcedureName\": \"Hepatitis C Virus (HCV) in Adults Screening\",\n \"TechnicalEligibleDate\": \"06/02/2014\",\n \"ProfessionalEligibleDate\": \"06/02/2014\",\n \"Benefits\": [{\n \"EligibilityOrBenefit\": \"Deductible\",\n \"InsuranceType\": \"Medicare Part B\",\n \"Date\": [{\n \"Date\": \"01/18/2021\",\n \"Type\": \"Benefit\"\n }],\n \"TimePeriodQualifier\": \"Calendar Year\",\n \"MonetaryAmount\": \"$0.00\",\n \"Percent\": null,\n \"UsedDate\": null,\n \"IdentificationCode\": null,\n \"IdentificationType\": null\n }, {\n \"EligibilityOrBenefit\": \"Co-Insurance\",\n \"InsuranceType\": \"Medicare Part B\",\n \"Date\": [{\n \"Date\": \"01/18/2021\",\n \"Type\": \"Benefit\"\n }],\n \"TimePeriodQualifier\": \"Visit\",\n \"MonetaryAmount\": null,\n \"Percent\": \"0%\",\n \"UsedDate\": null,\n \"IdentificationCode\": null,\n \"IdentificationType\": null\n }]\n}, {\n \"ProcedureCode\": \"HCPCS|G0447\",\n \"ProcedureName\": \"Intensive Behavioral Counselling for Obesity\",\n \"TechnicalEligibleDate\": \"11/29/2011\",\n \"ProfessionalEligibleDate\": \"11/29/2011\",\n \"Benefits\": [{\n \"EligibilityOrBenefit\": \"Deductible\",\n \"InsuranceType\": \"Medicare Part B\",\n \"Date\": [{\n \"Date\": \"01/18/2021\",\n \"Type\": \"Benefit\"\n }],\n \"TimePeriodQualifier\": \"Calendar Year\",\n \"MonetaryAmount\": \"$0.00\",\n \"Percent\": null,\n \"UsedDate\": null,\n \"IdentificationCode\": null,\n \"IdentificationType\": null\n }, {\n \"EligibilityOrBenefit\": \"Co-Insurance\",\n \"InsuranceType\": \"Medicare Part B\",\n \"Date\": [{\n \"Date\": \"01/18/2021\",\n \"Type\": \"Benefit\"\n }],\n \"TimePeriodQualifier\": \"Visit\",\n \"MonetaryAmount\": null,\n \"Percent\": \"0%\",\n \"UsedDate\": null,\n \"IdentificationCode\": null,\n \"IdentificationType\": null\n }]\n}, {\n \"ProcedureCode\": \"HCPCS|G0473\",\n \"ProcedureName\": \"Intensive Behavioral Counselling for Obesity\",\n \"TechnicalEligibleDate\": \"01/01/2015\",\n \"ProfessionalEligibleDate\": \"01/01/2015\",\n \"Benefits\": [{\n \"EligibilityOrBenefit\": \"Deductible\",\n \"InsuranceType\": \"Medicare Part B\",\n \"Date\": [{\n \"Date\": \"01/18/2021\",\n \"Type\": \"Benefit\"\n }],\n \"TimePeriodQualifier\": \"Calendar Year\",\n \"MonetaryAmount\": \"$0.00\",\n \"Percent\": null,\n \"UsedDate\": null,\n \"IdentificationCode\": null,\n \"IdentificationType\": null\n }, {\n \"EligibilityOrBenefit\": \"Co-Insurance\",\n \"InsuranceType\": \"Medicare Part B\",\n \"Date\": [{\n \"Date\": \"01/18/2021\",\n \"Type\": \"Benefit\"\n }],\n \"TimePeriodQualifier\": \"Visit\",\n \"MonetaryAmount\": null,\n \"Percent\": \"0%\",\n \"UsedDate\": null,\n \"IdentificationCode\": null,\n \"IdentificationType\": null\n }]\n}, {\n \"ProcedureCode\": \"HCPCS|G0106\",\n \"ProcedureName\": \"Colorectal Cancer Screening (COLO)\",\n \"TechnicalEligibleDate\": \"04/23/1998\",\n \"ProfessionalEligibleDate\": \"04/23/1998\",\n \"Benefits\": [{\n \"EligibilityOrBenefit\": \"Deductible\",\n \"InsuranceType\": \"Medicare Part B\",\n \"Date\": [{\n \"Date\": \"01/18/2021\",\n \"Type\": \"Benefit\"\n }],\n \"TimePeriodQualifier\": \"Calendar Year\",\n \"MonetaryAmount\": \"$0.00\",\n \"Percent\": null,\n \"UsedDate\": null,\n \"IdentificationCode\": null,\n \"IdentificationType\": null\n }]\n}, {\n \"ProcedureCode\": \"HCPCS|71271\",\n \"ProcedureName\": \"Computed tomography, thorax, low dose for lung cancer screening, without contrast material(s)\",\n \"TechnicalEligibleDate\": \"02/05/2015\",\n \"ProfessionalEligibleDate\": \"02/05/2015\",\n \"Benefits\": [{\n \"EligibilityOrBenefit\": \"Deductible\",\n \"InsuranceType\": \"Medicare Part B\",\n \"Date\": [{\n \"Date\": \"01/18/2021\",\n \"Type\": \"Benefit\"\n }],\n \"TimePeriodQualifier\": \"Calendar Year\",\n \"MonetaryAmount\": \"$0.00\",\n \"Percent\": null,\n \"UsedDate\": null,\n \"IdentificationCode\": null,\n \"IdentificationType\": null\n }, {\n \"EligibilityOrBenefit\": \"Co-Insurance\",\n \"InsuranceType\": \"Medicare Part B\",\n \"Date\": [{\n \"Date\": \"01/18/2021\",\n \"Type\": \"Benefit\"\n }],\n \"TimePeriodQualifier\": \"Visit\",\n \"MonetaryAmount\": null,\n \"Percent\": \"0%\",\n \"UsedDate\": null,\n \"IdentificationCode\": null,\n \"IdentificationType\": null\n }]\n}, {\n \"ProcedureCode\": \"HCPCS|G0475\",\n \"ProcedureName\": \"Human Immunodeficiency Virus (HIV) Infection Screening\",\n \"TechnicalEligibleDate\": \"04/13/2015\",\n \"ProfessionalEligibleDate\": null,\n \"Benefits\": [{\n \"EligibilityOrBenefit\": \"Deductible\",\n \"InsuranceType\": \"Medicare Part B\",\n \"Date\": [{\n \"Date\": \"01/18/2021\",\n \"Type\": \"Benefit\"\n }],\n \"TimePeriodQualifier\": \"Calendar Year\",\n \"MonetaryAmount\": \"$0.00\",\n \"Percent\": null,\n \"UsedDate\": null,\n \"IdentificationCode\": null,\n \"IdentificationType\": null\n }, {\n \"EligibilityOrBenefit\": \"Co-Insurance\",\n \"InsuranceType\": \"Medicare Part B\",\n \"Date\": [{\n \"Date\": \"01/18/2021\",\n \"Type\": \"Benefit\"\n }],\n \"TimePeriodQualifier\": \"Visit\",\n \"MonetaryAmount\": null,\n \"Percent\": \"0%\",\n \"UsedDate\": null,\n \"IdentificationCode\": null,\n \"IdentificationType\": null\n }]\n}, {\n \"ProcedureCode\": \"HCPCS|G0103\",\n \"ProcedureName\": \"Prostate Cancer Screening (PROS)\",\n \"TechnicalEligibleDate\": \"11/01/2001\",\n \"ProfessionalEligibleDate\": \"02/01/2005\",\n \"Benefits\": [{\n \"EligibilityOrBenefit\": \"Deductible\",\n \"InsuranceType\": \"Medicare Part B\",\n \"Date\": [{\n \"Date\": \"01/18/2021\",\n \"Type\": \"Benefit\"\n }],\n \"TimePeriodQualifier\": \"Calendar Year\",\n \"MonetaryAmount\": \"$0.00\",\n \"Percent\": null,\n \"UsedDate\": null,\n \"IdentificationCode\": null,\n \"IdentificationType\": null\n }, {\n \"EligibilityOrBenefit\": \"Co-Insurance\",\n \"InsuranceType\": \"Medicare Part B\",\n \"Date\": [{\n \"Date\": \"01/18/2021\",\n \"Type\": \"Benefit\"\n }],\n \"TimePeriodQualifier\": \"Visit\",\n \"MonetaryAmount\": null,\n \"Percent\": \"0%\",\n \"UsedDate\": null,\n \"IdentificationCode\": null,\n \"IdentificationType\": null\n }]\n}, {\n \"ProcedureCode\": \"HCPCS|80061\",\n \"ProcedureName\": \"Cardiovascular Disease Screening (CARD)\",\n \"TechnicalEligibleDate\": \"01/01/2005\",\n \"ProfessionalEligibleDate\": \"01/01/2005\",\n \"Benefits\": [{\n \"EligibilityOrBenefit\": \"Deductible\",\n \"InsuranceType\": \"Medicare Part B\",\n \"Date\": [{\n \"Date\": \"01/18/2021\",\n \"Type\": \"Benefit\"\n }],\n \"TimePeriodQualifier\": \"Calendar Year\",\n \"MonetaryAmount\": \"$0.00\",\n \"Percent\": null,\n \"UsedDate\": null,\n \"IdentificationCode\": null,\n \"IdentificationType\": null\n }, {\n \"EligibilityOrBenefit\": \"Co-Insurance\",\n \"InsuranceType\": \"Medicare Part B\",\n \"Date\": [{\n \"Date\": \"01/18/2021\",\n \"Type\": \"Benefit\"\n }],\n \"TimePeriodQualifier\": \"Visit\",\n \"MonetaryAmount\": null,\n \"Percent\": \"0%\",\n \"UsedDate\": null,\n \"IdentificationCode\": null,\n \"IdentificationType\": null\n }]\n}, {\n \"ProcedureCode\": \"HCPCS|81528\",\n \"ProcedureName\": \"Colorectal Cancer Screening (COLO)\",\n \"TechnicalEligibleDate\": \"10/09/2014\",\n \"ProfessionalEligibleDate\": null,\n \"Benefits\": [{\n \"EligibilityOrBenefit\": \"Deductible\",\n \"InsuranceType\": \"Medicare Part B\",\n \"Date\": [{\n \"Date\": \"01/18/2021\",\n \"Type\": \"Benefit\"\n }],\n \"TimePeriodQualifier\": \"Calendar Year\",\n \"MonetaryAmount\": \"$0.00\",\n \"Percent\": null,\n \"UsedDate\": null,\n \"IdentificationCode\": null,\n \"IdentificationType\": null\n }, {\n \"EligibilityOrBenefit\": \"Co-Insurance\",\n \"InsuranceType\": \"Medicare Part B\",\n \"Date\": [{\n \"Date\": \"01/18/2021\",\n \"Type\": \"Benefit\"\n }],\n \"TimePeriodQualifier\": \"Visit\",\n \"MonetaryAmount\": null,\n \"Percent\": \"0%\",\n \"UsedDate\": null,\n \"IdentificationCode\": null,\n \"IdentificationType\": null\n }]\n}, {\n \"ProcedureCode\": \"HCPCS|82950\",\n \"ProcedureName\": \"Diabetes Screening Tests (DIAB)\",\n \"TechnicalEligibleDate\": \"01/01/2005\",\n \"ProfessionalEligibleDate\": \"01/01/2005\",\n \"Benefits\": [{\n \"EligibilityOrBenefit\": \"Deductible\",\n \"InsuranceType\": \"Medicare Part B\",\n \"Date\": [{\n \"Date\": \"01/18/2021\",\n \"Type\": \"Benefit\"\n }],\n \"TimePeriodQualifier\": \"Calendar Year\",\n \"MonetaryAmount\": \"$0.00\",\n \"Percent\": null,\n \"UsedDate\": null,\n \"IdentificationCode\": null,\n \"IdentificationType\": null\n }, {\n \"EligibilityOrBenefit\": \"Co-Insurance\",\n \"InsuranceType\": \"Medicare Part B\",\n \"Date\": [{\n \"Date\": \"01/18/2021\",\n \"Type\": \"Benefit\"\n }],\n \"TimePeriodQualifier\": \"Visit\",\n \"MonetaryAmount\": null,\n \"Percent\": \"0%\",\n \"UsedDate\": null,\n \"IdentificationCode\": null,\n \"IdentificationType\": null\n }]\n}, {\n \"ProcedureCode\": \"HCPCS|G0104\",\n \"ProcedureName\": \"Colorectal Cancer Screening (COLO)\",\n \"TechnicalEligibleDate\": \"04/23/1998\",\n \"ProfessionalEligibleDate\": \"04/23/1998\",\n \"Benefits\": [{\n \"EligibilityOrBenefit\": \"Deductible\",\n \"InsuranceType\": \"Medicare Part B\",\n \"Date\": [{\n \"Date\": \"01/18/2021\",\n \"Type\": \"Benefit\"\n }],\n \"TimePeriodQualifier\": \"Calendar Year\",\n \"MonetaryAmount\": \"$0.00\",\n \"Percent\": null,\n \"UsedDate\": null,\n \"IdentificationCode\": null,\n \"IdentificationType\": null\n }, {\n \"EligibilityOrBenefit\": \"Co-Insurance\",\n \"InsuranceType\": \"Medicare Part B\",\n \"Date\": [{\n \"Date\": \"01/18/2021\",\n \"Type\": \"Benefit\"\n }],\n \"TimePeriodQualifier\": \"Visit\",\n \"MonetaryAmount\": null,\n \"Percent\": \"0%\",\n \"UsedDate\": null,\n \"IdentificationCode\": null,\n \"IdentificationType\": null\n }]\n}, {\n \"ProcedureCode\": \"HCPCS|G0445\",\n \"ProcedureName\": \"Screening and High Intensive Behavioral Counseling (HIBC) to prevent STIs\",\n \"TechnicalEligibleDate\": \"11/08/2011\",\n \"ProfessionalEligibleDate\": \"11/08/2011\",\n \"Benefits\": [{\n \"EligibilityOrBenefit\": \"Deductible\",\n \"InsuranceType\": \"Medicare Part B\",\n \"Date\": [{\n \"Date\": \"01/18/2021\",\n \"Type\": \"Benefit\"\n }],\n \"TimePeriodQualifier\": \"Calendar Year\",\n \"MonetaryAmount\": \"$0.00\",\n \"Percent\": null,\n \"UsedDate\": null,\n \"IdentificationCode\": null,\n \"IdentificationType\": null\n }, {\n \"EligibilityOrBenefit\": \"Co-Insurance\",\n \"InsuranceType\": \"Medicare Part B\",\n \"Date\": [{\n \"Date\": \"01/18/2021\",\n \"Type\": \"Benefit\"\n }],\n \"TimePeriodQualifier\": \"Visit\",\n \"MonetaryAmount\": null,\n \"Percent\": \"0%\",\n \"UsedDate\": null,\n \"IdentificationCode\": null,\n \"IdentificationType\": null\n }]\n}, {\n \"ProcedureCode\": \"HCPCS|82951\",\n \"ProcedureName\": \"Diabetes Screening Tests (DIAB)\",\n \"TechnicalEligibleDate\": \"01/01/2005\",\n \"ProfessionalEligibleDate\": \"01/01/2005\",\n \"Benefits\": [{\n \"EligibilityOrBenefit\": \"Deductible\",\n \"InsuranceType\": \"Medicare Part B\",\n \"Date\": [{\n \"Date\": \"01/18/2021\",\n \"Type\": \"Benefit\"\n }],\n \"TimePeriodQualifier\": \"Calendar Year\",\n \"MonetaryAmount\": \"$0.00\",\n \"Percent\": null,\n \"UsedDate\": null,\n \"IdentificationCode\": null,\n \"IdentificationType\": null\n }, {\n \"EligibilityOrBenefit\": \"Co-Insurance\",\n \"InsuranceType\": \"Medicare Part B\",\n \"Date\": [{\n \"Date\": \"01/18/2021\",\n \"Type\": \"Benefit\"\n }],\n \"TimePeriodQualifier\": \"Visit\",\n \"MonetaryAmount\": null,\n \"Percent\": \"0%\",\n \"UsedDate\": null,\n \"IdentificationCode\": null,\n \"IdentificationType\": null\n }]\n}, {\n \"ProcedureCode\": \"HCPCS|G0439\",\n \"ProcedureName\": \"Annual Wellness Visit (AMV)\",\n \"TechnicalEligibleDate\": null,\n \"ProfessionalEligibleDate\": \"01/01/2011\",\n \"Benefits\": [{\n \"EligibilityOrBenefit\": \"Deductible\",\n \"InsuranceType\": \"Medicare Part B\",\n \"Date\": [{\n \"Date\": \"01/18/2021\",\n \"Type\": \"Benefit\"\n }],\n \"TimePeriodQualifier\": \"Calendar Year\",\n \"MonetaryAmount\": \"$0.00\",\n \"Percent\": null,\n \"UsedDate\": null,\n \"IdentificationCode\": null,\n \"IdentificationType\": null\n }, {\n \"EligibilityOrBenefit\": \"Co-Insurance\",\n \"InsuranceType\": \"Medicare Part B\",\n \"Date\": [{\n \"Date\": \"01/18/2021\",\n \"Type\": \"Benefit\"\n }],\n \"TimePeriodQualifier\": \"Visit\",\n \"MonetaryAmount\": null,\n \"Percent\": \"0%\",\n \"UsedDate\": null,\n \"IdentificationCode\": null,\n \"IdentificationType\": null\n }]\n}, {\n \"ProcedureCode\": \"HCPCS|82270\",\n \"ProcedureName\": \"Fecal Occult Blood Test\",\n \"TechnicalEligibleDate\": \"01/01/2007\",\n \"ProfessionalEligibleDate\": \"01/01/2007\",\n \"Benefits\": [{\n \"EligibilityOrBenefit\": \"Deductible\",\n \"InsuranceType\": \"Medicare Part B\",\n \"Date\": [{\n \"Date\": \"01/18/2021\",\n \"Type\": \"Benefit\"\n }],\n \"TimePeriodQualifier\": \"Calendar Year\",\n \"MonetaryAmount\": \"$0.00\",\n \"Percent\": null,\n \"UsedDate\": null,\n \"IdentificationCode\": null,\n \"IdentificationType\": null\n }, {\n \"EligibilityOrBenefit\": \"Co-Insurance\",\n \"InsuranceType\": \"Medicare Part B\",\n \"Date\": [{\n \"Date\": \"01/18/2021\",\n \"Type\": \"Benefit\"\n }],\n \"TimePeriodQualifier\": \"Visit\",\n \"MonetaryAmount\": null,\n \"Percent\": \"0%\",\n \"UsedDate\": null,\n \"IdentificationCode\": null,\n \"IdentificationType\": null\n }]\n}, {\n \"ProcedureCode\": \"HCPCS|G0120\",\n \"ProcedureName\": \"Colorectal Cancer Screening (COLO)\",\n \"TechnicalEligibleDate\": \"04/23/1998\",\n \"ProfessionalEligibleDate\": \"04/23/1998\",\n \"Benefits\": [{\n \"EligibilityOrBenefit\": \"Deductible\",\n \"InsuranceType\": \"Medicare Part B\",\n \"Date\": [{\n \"Date\": \"01/18/2021\",\n \"Type\": \"Benefit\"\n }],\n \"TimePeriodQualifier\": \"Calendar Year\",\n \"MonetaryAmount\": \"$0.00\",\n \"Percent\": null,\n \"UsedDate\": null,\n \"IdentificationCode\": null,\n \"IdentificationType\": null\n }]\n}, {\n \"ProcedureCode\": \"HCPCS|G0121\",\n \"ProcedureName\": \"Colorectal Cancer Screening (COLO)\",\n \"TechnicalEligibleDate\": \"07/01/2001\",\n \"ProfessionalEligibleDate\": \"07/01/2001\",\n \"Benefits\": [{\n \"EligibilityOrBenefit\": \"Deductible\",\n \"InsuranceType\": \"Medicare Part B\",\n \"Date\": [{\n \"Date\": \"01/18/2021\",\n \"Type\": \"Benefit\"\n }],\n \"TimePeriodQualifier\": \"Calendar Year\",\n \"MonetaryAmount\": \"$0.00\",\n \"Percent\": null,\n \"UsedDate\": null,\n \"IdentificationCode\": null,\n \"IdentificationType\": null\n }, {\n \"EligibilityOrBenefit\": \"Co-Insurance\",\n \"InsuranceType\": \"Medicare Part B\",\n \"Date\": [{\n \"Date\": \"01/18/2021\",\n \"Type\": \"Benefit\"\n }],\n \"TimePeriodQualifier\": \"Visit\",\n \"MonetaryAmount\": null,\n \"Percent\": \"0%\",\n \"UsedDate\": null,\n \"IdentificationCode\": null,\n \"IdentificationType\": null\n }]\n}, {\n \"ProcedureCode\": \"HCPCS|76977\",\n \"ProcedureName\": \"Ultrasound Bone Density Measurement and Interpretation\",\n \"TechnicalEligibleDate\": \"07/01/1998\",\n \"ProfessionalEligibleDate\": \"07/01/1998\",\n \"Benefits\": [{\n \"EligibilityOrBenefit\": \"Deductible\",\n \"InsuranceType\": \"Medicare Part B\",\n \"Date\": [{\n \"Date\": \"01/18/2021\",\n \"Type\": \"Benefit\"\n }],\n \"TimePeriodQualifier\": \"Calendar Year\",\n \"MonetaryAmount\": \"$0.00\",\n \"Percent\": null,\n \"UsedDate\": null,\n \"IdentificationCode\": null,\n \"IdentificationType\": null\n }, {\n \"EligibilityOrBenefit\": \"Co-Insurance\",\n \"InsuranceType\": \"Medicare Part B\",\n \"Date\": [{\n \"Date\": \"01/18/2021\",\n \"Type\": \"Benefit\"\n }],\n \"TimePeriodQualifier\": \"Visit\",\n \"MonetaryAmount\": null,\n \"Percent\": \"0%\",\n \"UsedDate\": null,\n \"IdentificationCode\": null,\n \"IdentificationType\": null\n }]\n}, {\n \"ProcedureCode\": \"HCPCS|77078\",\n \"ProcedureName\": \"Computed Tomography Bone Mineral Density Study\",\n \"TechnicalEligibleDate\": \"07/01/1998\",\n \"ProfessionalEligibleDate\": \"07/01/1998\",\n \"Benefits\": [{\n \"EligibilityOrBenefit\": \"Deductible\",\n \"InsuranceType\": \"Medicare Part B\",\n \"Date\": [{\n \"Date\": \"01/18/2021\",\n \"Type\": \"Benefit\"\n }],\n \"TimePeriodQualifier\": \"Calendar Year\",\n \"MonetaryAmount\": \"$0.00\",\n \"Percent\": null,\n \"UsedDate\": null,\n \"IdentificationCode\": null,\n \"IdentificationType\": null\n }, {\n \"EligibilityOrBenefit\": \"Co-Insurance\",\n \"InsuranceType\": \"Medicare Part B\",\n \"Date\": [{\n \"Date\": \"01/18/2021\",\n \"Type\": \"Benefit\"\n }],\n \"TimePeriodQualifier\": \"Visit\",\n \"MonetaryAmount\": null,\n \"Percent\": \"0%\",\n \"UsedDate\": null,\n \"IdentificationCode\": null,\n \"IdentificationType\": null\n }]\n}, {\n \"ProcedureCode\": \"HCPCS|77080\",\n \"ProcedureName\": \"Dual Energy X-ray Absorptiometry (DXA) Bone Density Study; axial skeleton\",\n \"TechnicalEligibleDate\": \"07/01/1998\",\n \"ProfessionalEligibleDate\": \"07/01/1998\",\n \"Benefits\": [{\n \"EligibilityOrBenefit\": \"Deductible\",\n \"InsuranceType\": \"Medicare Part B\",\n \"Date\": [{\n \"Date\": \"01/18/2021\",\n \"Type\": \"Benefit\"\n }],\n \"TimePeriodQualifier\": \"Calendar Year\",\n \"MonetaryAmount\": \"$0.00\",\n \"Percent\": null,\n \"UsedDate\": null,\n \"IdentificationCode\": null,\n \"IdentificationType\": null\n }, {\n \"EligibilityOrBenefit\": \"Co-Insurance\",\n \"InsuranceType\": \"Medicare Part B\",\n \"Date\": [{\n \"Date\": \"01/18/2021\",\n \"Type\": \"Benefit\"\n }],\n \"TimePeriodQualifier\": \"Visit\",\n \"MonetaryAmount\": null,\n \"Percent\": \"0%\",\n \"UsedDate\": null,\n \"IdentificationCode\": null,\n \"IdentificationType\": null\n }]\n}, {\n \"ProcedureCode\": \"HCPCS|77081\",\n \"ProcedureName\": \"DXA Bone Density Study; appendicular skeleton\",\n \"TechnicalEligibleDate\": \"07/01/1998\",\n \"ProfessionalEligibleDate\": \"07/01/1998\",\n \"Benefits\": [{\n \"EligibilityOrBenefit\": \"Deductible\",\n \"InsuranceType\": \"Medicare Part B\",\n \"Date\": [{\n \"Date\": \"01/18/2021\",\n \"Type\": \"Benefit\"\n }],\n \"TimePeriodQualifier\": \"Calendar Year\",\n \"MonetaryAmount\": \"$0.00\",\n \"Percent\": null,\n \"UsedDate\": null,\n \"IdentificationCode\": null,\n \"IdentificationType\": null\n }, {\n \"EligibilityOrBenefit\": \"Co-Insurance\",\n \"InsuranceType\": \"Medicare Part B\",\n \"Date\": [{\n \"Date\": \"01/18/2021\",\n \"Type\": \"Benefit\"\n }],\n \"TimePeriodQualifier\": \"Visit\",\n \"MonetaryAmount\": null,\n \"Percent\": \"0%\",\n \"UsedDate\": null,\n \"IdentificationCode\": null,\n \"IdentificationType\": null\n }]\n}, {\n \"ProcedureCode\": \"HCPCS|G0130\",\n \"ProcedureName\": \"Single Energy X-ray Study\",\n \"TechnicalEligibleDate\": \"07/01/1998\",\n \"ProfessionalEligibleDate\": \"07/01/1998\",\n \"Benefits\": [{\n \"EligibilityOrBenefit\": \"Deductible\",\n \"InsuranceType\": \"Medicare Part B\",\n \"Date\": [{\n \"Date\": \"01/18/2021\",\n \"Type\": \"Benefit\"\n }],\n \"TimePeriodQualifier\": \"Calendar Year\",\n \"MonetaryAmount\": \"$0.00\",\n \"Percent\": null,\n \"UsedDate\": null,\n \"IdentificationCode\": null,\n \"IdentificationType\": null\n }, {\n \"EligibilityOrBenefit\": \"Co-Insurance\",\n \"InsuranceType\": \"Medicare Part B\",\n \"Date\": [{\n \"Date\": \"01/18/2021\",\n \"Type\": \"Benefit\"\n }],\n \"TimePeriodQualifier\": \"Visit\",\n \"MonetaryAmount\": null,\n \"Percent\": \"0%\",\n \"UsedDate\": null,\n \"IdentificationCode\": null,\n \"IdentificationType\": null\n }]\n}, {\n \"ProcedureCode\": \"HCPCS|G0118\",\n \"ProcedureName\": \"Glaucoma Screening (GLAU)\",\n \"TechnicalEligibleDate\": \"01/01/2002\",\n \"ProfessionalEligibleDate\": \"01/01/2002\",\n \"Benefits\": null\n}, {\n \"ProcedureCode\": \"HCPCS|G0102\",\n \"ProcedureName\": \"Prostate Cancer Screening (PROS)\",\n \"TechnicalEligibleDate\": \"01/01/2000\",\n \"ProfessionalEligibleDate\": \"01/01/2000\",\n \"Benefits\": null\n}, {\n \"ProcedureCode\": \"HCPCS|G0117\",\n \"ProcedureName\": \"Glaucoma Screening (GLAU)\",\n \"TechnicalEligibleDate\": \"01/01/2002\",\n \"ProfessionalEligibleDate\": \"01/01/2002\",\n \"Benefits\": null\n}]\n\nUsing EligibilitySummary or EasyEligibilitySummary, for Medicare, you can obtain details in a new section \"MedicareInfoSummary\". The response object is to the right and returns SNF information, MCA information, Pharmacy payer, and other Medicare specific information.
\n \"MedicareInfoSummary\": {\n \"HospiceQty\": null,\n \"HospiceDate\": null,\n \"HomeHealthCareStartDate\": null,\n \"HomeHealthCareEndDate\": null,\n \"SkilledNursingCareStartDate\": null,\n \"SkilledNursingCareEndDate\": null,\n \"AdvantagePayerName\": null,\n \"AdvantageCOBDate\": null,\n \"AdvantagePolicyType\": null,\n \"PharmacyPayerName\": \"SILVERSCRIPT INSURANCE COMPANY\",\n \"PharmacyPayerPlanNumber\": \"S5601\",\n \"PharmacyPayerPlanNetworkID\": \"034\",\n \"WCAutoInjuryLiabilityPayerName\": null,\n \"WCAutoInjuryLiabilityCOBDate\": null,\n \"WCAutoInjuryLiabilityPolicyType\": null,\n \"QMBPolicyType\": null,\n \"Part_A_Deductible\": null,\n \"Part_A_Deductible_Remaining\": \"$1364.00\",\n \"Part_B_Deductible\": \"$185.00\",\n \"Part_B_Deductible_Remaining\": \"$0.00\",\n \"OT_UsedAmount\": null,\n \"PT_SLP_UsedAmount\": null\n },\n\nFurther under the OtherPayerInfo section you can find Third Party Administrators and other information.
\n \"OtherPayerInfo\": {\n \"PrimaryPayer\": null,\n \"Payer\": null,\n \"SecondaryPayer\": null,\n \"PlanSponsor\": null,\n \"IndependentPhysiciansAssociation_IPA\": null,\n \"WorkersCompensation\": null,\n \"ContractedServiceProvider\": null\n },\n\nAn important concept to understand with pVerify eligibility endpoints is the concept of a \"back office\" payer. To support 99% of available payers we need to connect to some payers via non-electronic means. These payers will not work with a real-time API with a immediate response expected.
\nGenerate Token
\nCall EligibilityInquiry to submit request to our queue and get elgRequestID
\nGenerate Token
\nCall EligibilityInquiry to submit request to our queue and get elgRequestID
\nAfter a period of 24 hours, call GetEligibilityResponse using elgRequestID above.
\nWe have two methods available for back-office queue management:
\nGetPendingInquiries this shows a list of your inquiries that are still in Pending state
\nCancelTransaction to set the state to Cancel and remove it from our queue.
\nTo simplify authorization and access to the pVerify API, we provide sample code in C# and libraries in Java. These libraries offer full access to the pVerify API with a minimum of code.
\n\n\n","schema":"https://schema.getpostman.com/json/collection/v2.0.0/collection.json","toc":[{"content":"Introduction","slug":"introduction"},{"content":"Available Endpoints","slug":"available-endpoints"},{"content":"Medicare HCPCS codes","slug":"medicare-hcpcs-codes"},{"content":"Medicare SNF and Other Information","slug":"medicare-snf-and-other-information"},{"content":"Backoffice Payers","slug":"backoffice-payers"},{"content":"Client Libraries and Sample Code","slug":"client-libraries-and-sample-code"}],"owner":"6948370","collectionId":"6ceb8797-50ff-42fd-98a3-64beefaa6c94","publishedId":"2s7ZE4NR6P","public":true,"customColor":{"top-bar":"FFFFFF","right-sidebar":"303030","highlight":"EF5B25"},"publishDate":"2022-09-22T10:46:13.000Z"},"item":[{"name":"Security and Authorization","item":[{"name":"Token","id":"d84ac4d8-db8b-47bb-b5c7-5c61726c8466","protocolProfileBehavior":{"disableBodyPruning":true},"request":{"method":"POST","header":[],"body":{"mode":"urlencoded","urlencoded":[{"key":"Client_Id","value":"{{client-api-id}}","type":"text"},{"key":"Client_Secret","value":"{{client-secret}}","type":"text"},{"key":"grant_type","value":"client_credentials","type":"text"},{"key":"","value":"","type":"text"}]},"url":"https://api.pverify.com/Token","description":"The first step to using the system is a call to the Token endpoint at /Token. It will return a token when you use in the subsequent calls.
\nToken Authorization Request
\n*Note: The Client-API-Id header is required. Header keys are case sensitive.
\nThe /Token response includes the following fields:
\n","urlObject":{"protocol":"https","path":["Token"],"host":["api","pverify","com"],"query":[],"variable":[]}},"response":[],"_postman_id":"d84ac4d8-db8b-47bb-b5c7-5c61726c8466"}],"id":"966c44b5-9f9f-4b12-bb28-dc903f6bf70c","description":"pVerify allows access to the Real-time Exchange System through the use of a client-api-id and client-secret. These must be requested from pVerify and are available via our API management site. The client-api-id and client-secret are used for the Token call, while the Token and client-api-id are used for subsequent calls. Please see the demo video for an example.
\nOnce the token is obtained, add these two headers to all subsequent calls:
\nAuthorization: Bearer (your token)
\nClient-API-Id: (your client ID from API Management site)
\n","event":[{"listen":"prerequest","script":{"id":"840276cb-fe48-45cb-9a9a-17e1ef5f6f9e","type":"text/javascript","exec":[""]}},{"listen":"test","script":{"id":"5e465b46-c6d8-4231-b239-943e328dfd5d","type":"text/javascript","exec":[""]}}],"_postman_id":"966c44b5-9f9f-4b12-bb28-dc903f6bf70c"},{"name":"Insurance Discovery","item":[{"name":"InsuranceDiscovery","id":"a8980dd4-58b0-4bce-9dd7-d6a2c15657b4","protocolProfileBehavior":{"disableBodyPruning":true},"request":{"method":"POST","header":[{"key":"Authorization","value":"Bearer {{access-token}}","type":"text"},{"key":"Client-API-Id","value":"{{client-api-id}}","type":"text"},{"key":"Content-Type","value":"application/json","type":"text"}],"body":{"mode":"raw","raw":"{\"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 }"},"url":"https://api.pverify.com/api/InsuranceDiscovery","description":"pVerify’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.
\nPatient States
To 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.
Medicare
We 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.
Headers
\n*Note: The Client-API-Id is required. Header keys are case sensitive.
\nGetInusuranceDiscoverySummaryResponse returns the response from the InsuranceDiscovery POST call using a unique request id provided in the InsuranceDiscovery response.
\nHeaders
\n*Note: The Client-API-Id header is required. Header keys are case sensitive.
\nSee InsuranceDiscovery response.
\n","urlObject":{"protocol":"https","path":["api","GetInusuranceDiscoverySummaryResponse","467"],"host":["api","pverify","com"],"query":[],"variable":[]}},"response":[],"_postman_id":"bea7d441-f998-4d72-8e50-7858b027bcb1"},{"name":"ID Details URL","id":"75555e77-f971-475a-9e83-868b8601ffdc","protocolProfileBehavior":{"disableBodyPruning":true},"request":{"method":"GET","header":[{"key":"Authorization","value":"Bearer {{access-token}}","type":"text"},{"key":"Client-API-Id","value":"{{client-api-id}}","type":"text"},{"key":"Content-Type","value":"application/json","type":"text"}],"url":"https://api.pverify.com/API/GetInsuranceDiscoveryDetailsURL/{requestID}","description":"This GET method will return details URL with Insurance Discovery Request ID as a parameter.
\nGetInsuranceDiscoveryDetailsURL Request
\n*Note: The Client-API-Id header is required. Header keys are case sensitive.
\nGetInsuranceDiscoveryDetailsURL Resposne
\nJSON Response
\n{
\n\"isDetailsURLGenerated\": true,
\n\"url\": \"https://premium.pverify.com/Details\",
\n\"errorMessage\": null
\n}
\n","urlObject":{"protocol":"https","path":["API","GetInsuranceDiscoveryDetailsURL","{requestID}"],"host":["api","pverify","com"],"query":[],"variable":[]}},"response":[],"_postman_id":"75555e77-f971-475a-9e83-868b8601ffdc"},{"name":"Insurance Discovery Report","id":"a285b3a5-e70d-4ee9-8fd2-4b1957e11d55","protocolProfileBehavior":{"disableBodyPruning":true},"request":{"method":"GET","header":[{"key":"Content-Type","value":"application/json","type":"text"},{"key":"Client-API-Id","value":"xxx","type":"text"},{"key":"Client-Secret","value":"xxx","type":"text"}],"url":"https://premium.pverify.com/PDFReport/InsuranceDiscovery/{id}","description":"This returns a PDF report of the Insurance Discovery request.
\nNote two things:
\nThe endpoint is premium.pverify.com
\nAuthentication token is not used, instead pass your API ID and Secret.
\nReplace {id} with the requestid you receive from the Insurance Discovery request.
Eligibility 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.
\nKey benefits are:
\nEasy and discrete eligibility information, allowing easy coding to obtain pertinent data.
\nSupport for nearly all types of medical practices with key benefits such as surgical benefits, DME benefits, or PT benefits.
\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
\nTo see the currently supported practice types please see the Practice Type tables.
\nMedicare
We 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.
Recursive Medicare Advantage Lookup
This 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.
Thus the workflow is this:
\nHeaders
\n*Note: The Client-API-Id is required. Header keys are case sensitive.
\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.
\nHeaders
\n*Note: The Client-API-Id header is required. Header keys are case sensitive.
\nSee EligibilitySummary response.
\n","urlObject":{"protocol":"https","path":["API","GetEligibilitySummary","9882795"],"host":["api","pverify","com"],"query":[],"variable":[]}},"response":[],"_postman_id":"f91239c0-309c-4547-8cfc-90c67795e9c5"},{"name":"GetEligibility271","id":"31b0db46-334f-4ffa-bb0a-3f084efe6b2f","protocolProfileBehavior":{"disableBodyPruning":true},"request":{"auth":{"type":"noauth","isInherited":false},"method":"GET","header":[{"key":"Authorization","value":"Bearer {{access-token}}"},{"key":"Client-API-Id","value":"{{client-api-id}}"},{"key":"Content-Type","value":"application/json"}],"url":"https://api.pverify.com/API/GetEligibility271/1111","description":"This GET method will return EDI 271 Raw response with Eligibility Request ID as a parameter.
\nGetEligibility271 Request
\n*Note: The Client-API-Id header is required. Header keys are case sensitive.
\nGetEligibility271 Response
\n","urlObject":{"protocol":"https","path":["API","GetEligibility271","1111"],"host":["api","pverify","com"],"query":[],"variable":[]}},"response":[],"_postman_id":"31b0db46-334f-4ffa-bb0a-3f084efe6b2f"},{"name":"EasyEligibilitySummary","id":"c7e02c3a-a5ff-41b0-b6e1-4712b7fb8acf","protocolProfileBehavior":{"disableBodyPruning":true},"request":{"method":"POST","header":[{"key":"Client-API-Id","type":"text","value":"{{client-api-id}}"},{"key":"Client-Secret","type":"text","value":"{{client-secret}}"},{"key":"Content-Type","type":"text","value":"application/json"}],"body":{"mode":"raw","raw":"{\r\n\t\"payerCode\": \"00001\",\r\n\t\"payerName\": \"Aetna\",\r\n\t\"Provider_LastName\": \"SAM MD\",\r\n\t\"Provider_NPI\": \"1234567890\",\r\n \"Provider_PIN\":\"00000\",\r\n\t\"Patient_First\": \"John\",\r\n\t\"Patient_DOB\": \"10/02/2010\",\r\n\t\"Patient_Last\": \"Deo\",\r\n\t\"memberID\": \"123456789A\",\r\n\t\"Date_Of_Service\": \"07/17/2020\",\r\n\t\"referenceId\": \"\",\r\n\t\"Location\": \"\",\r\n\t\"PracticeTypeCode\": \"18\",\r\n\t\"IncludeTextResponse\": false,\r\n \"InternalId\":\"\",\r\n \"CustomerID\":\"\"\r\n}","options":{"raw":{"language":"json"}}},"url":"https://api.pverify.com/API/EasyEligibilitySummary","description":"The 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.
\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.
\nGetPendingInquiries Request
\n","urlObject":{"protocol":"https","path":["API","GetPendingInquiries"],"host":["api","pverify","com"],"query":[{"key":"DOS","value":"01-01-2018"}],"variable":[]}},"response":[],"_postman_id":"9708c8f4-b7af-423f-9f7f-fa8ab05a9e2b"},{"name":"CancelTransaction","id":"6c6d5192-279f-4a19-ae56-7d05ce901c4b","protocolProfileBehavior":{"disableBodyPruning":true},"request":{"method":"POST","header":[{"key":"Authorization","value":"Bearer {{access-token}}"},{"key":"Client-API-Id","value":"{{client-api-id}}"},{"key":"Content-Type","value":"application/json"}],"body":{"mode":"raw","raw":"{\r\n\"transactionId\":12345455\r\n}"},"url":"https://api.pverify.com/API/CancelTransaction","description":"This 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.
\nCancelTransaction Request
\n*Note: The Client-API-Id is required in header. Header keys are case sensitive.
\n","urlObject":{"protocol":"https","path":["API","CancelTransaction"],"host":["api","pverify","com"],"query":[],"variable":[]}},"response":[],"_postman_id":"6c6d5192-279f-4a19-ae56-7d05ce901c4b"},{"name":"EligibilityPDFReport","id":"ec730ff0-34aa-4056-a99c-4f791fd6008b","protocolProfileBehavior":{"disableBodyPruning":true},"request":{"method":"GET","header":[{"key":"Client-API-Id","value":"{{client-api-id}}"},{"key":"Client-Secret","value":"{{client-secret}}","type":"text"},{"key":"Content-Type","value":"application/json"}],"url":"https://premium.pverify.com/Report/EligibilityPDFReport/This GET method will return details URL with Eligibility Request ID as a parameter.
\nGetEligibilityDetailsURL Request
\n*Note: The Client-API-Id header is required. Header keys are case sensitive.
\nGetEligibilityDetailsURL Resposne
\nJSON Response
\n{
\n\"isDetailsURLGenerated\": true,
\n\"url\": \"https://premium.pverify.com/Details\",
\n\"errorMessage\": null
\n}
\n","urlObject":{"protocol":"https","path":["API","GetEligibilityDetailsURL","{requestID}"],"host":["api","pverify","com"],"query":[],"variable":[]}},"response":[],"_postman_id":"c9008120-4d00-4539-af47-525d789b1b1a"}],"id":"f616b939-f39a-41dc-92c8-cdcc96da2d06","_postman_id":"f616b939-f39a-41dc-92c8-cdcc96da2d06","description":""},{"name":"Dental Eligibility","item":[{"name":"DentalEligibilitySummary","id":"f9194243-51e7-457f-9c0e-756ef5ee45f6","protocolProfileBehavior":{"disableBodyPruning":true},"request":{"method":"POST","header":[{"key":"Authorization","value":"Bearer {{access-token}}","type":"text"},{"key":"Client-API-Id","value":"{{client-api-id}}","type":"text"},{"key":"Content-Type","value":"application/json","type":"text"}],"body":{"mode":"raw","raw":"{\r\n\t\"payerCode\": \"DE0171\",\r\n\t\"payerName\": \"Delta Dental of Washington\",\r\n\r\n\t\"provider\": {\r\n\t\t\"firstName\": \"\",\r\n\t\t\"middleName\": \"\",\r\n\t\t\"lastName\": \" test name\",\r\n\t\t\"npi\": \"1427006147\",\r\n \"TaxId\":\"123456789\"\r\n\t},\r\n\t\"subscriber\": {\r\n\t\t\"firstName\": \"\",\r\n\t\t\"dob\": \"01/01/1950\",\r\n\t\t\"lastName\": \"\",\r\n\t\t\"memberID\": \"1234567890\"\r\n\t},\r\n\t\"dependent\": null,\r\n\r\n\t\"isSubscriberPatient\": \"True\",\r\n\t\"doS_StartDate\": \"02/02/2021\",\r\n\t\"doS_EndDate\": \"02/02/2021\",\r\n\r\n\t\"PracticeTypeCode\": \"86\",\r\n\t\"referenceId\": \"Pat MRN\",\r\n\t\"Location\": \"Any location Name\",\r\n\t\"IncludeHtmlResponse\": false,\r\n \"dCodes\": [\r\n \"D0120\",\r\n \"D0145\"\r\n ]\r\n\r\n}"},"url":"https://api.pverify.com/api/DentalEligibilitySummary","description":"There two type of verifications Self and Dependent.
\nThere two type of verifications Self and Dependent.
\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.
\nHeaders
\n*Note: The Client-API-Id header is required. Header keys are case sensitive.
\nThere two type of verifications Self and Dependent.
\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.
\nHeaders
\n*Note: The Client-API-Id header is required. Header keys are case sensitive.
\nThis POST call will get an estimated price from CMS (Medicare) non-facility price index. In order for you to use this, we must add the estimator service (which is free) to your account. Additionally, for the Zip code, use 0 for national pricing, and you can send an array of CPT codes per the Postman example. Please note, due to the nature of the EstimateCalculation call, no test credentials are available.
\n*Note: The Client-API-Id is required in header. Header keys are case sensitive.
\n+The deductible must be met before insurance applies. For example, if the deductible remaining is 1000, then the patient will have to pay out of pocket $1000 for next procedure as long as the procedure amount > $1000.
++This is typically a high number. Once it reaches zero, the patient responsibility is zero. It is designed for catastrophic coverage ie: major surgery or chemotherapy.
pVerify has two RESTful API end points to provide CGX information,\nThe workflow is:
\nNote** : Same Token can be used in subsequent inquiries.
\n","event":[{"listen":"prerequest","script":{"id":"2cba9519-131c-4fbd-bd5c-2537fca7e2a1","type":"text/javascript","exec":[""]}},{"listen":"test","script":{"id":"13128ba0-84a1-47fe-ac24-9175e1c8125f","type":"text/javascript","exec":[""]}}],"_postman_id":"e299c681-6132-4c00-ad79-a571628ae521"},{"name":"MBI look up","item":[{"name":"MBIInquiry","id":"ddbb67c4-b856-4002-8acf-63e9e39fb186","protocolProfileBehavior":{"disableBodyPruning":true,"disabledSystemHeaders":{"content-type":true}},"request":{"method":"POST","header":[{"key":"Client-API-Id","value":"{{client-api-id}}","type":"text"},{"key":"Authorization","value":"Bearer {{auth-token}}","type":"text"},{"key":"Content-Type","value":"application/json","type":"text"}],"body":{"mode":"raw","raw":"{\r\n \"ProviderLastName\": \"ProviderLastName\",\r\n \"ProviderNPI\": \"1234567890\",\r\n \"PatientFirstName\": \"John\",\r\n \"PatientDOB\": \"07/15/1956\",\r\n \"PatientLastName\": \"Doe\",\r\n \"PatientSSN_or_HICN\": \"\",\r\n \"PatientSSN\": \"\",\r\n \"MRN\": \"1234\",\r\n \"Location\": \"\",\r\n \"Address\": {\r\n \"AddressLine1\": null,\r\n \"City\": null,\r\n \"State\": \"MD\",\r\n \"ZipCode\": null\r\n }\r\n}"},"url":"https://api.pverify.com/API/MBIInquiry","description":"MBI Skip Mechanism:
\nA transaction will be skipped if another transaction with same parameters(First Name, Last Name, Date of Birth (DOB), State, and SSN) is run in the current Calander month that is Processed/Processed with valid error
\nThis call is used to get the transaction result later using unique request id which is returned in MBIInquiry API call.
\nSample Response
\n{ \n \"RequestId\": \"482672\",\n \"Status\":\"Processed\",\n\"ErrorMessage\": null,\n \"PatientSSN\": \"123XXXXXX\",\n\"PatientFirstName\": \"PatientFirstName\",\n\"PatientLastName\": \"PatientLastName\",\n\"PatientDOB\": \"mm/dd/yyyy\",\n\"MBI\": \"234XXXXXXXXX\",\n\"MRN\": \"123435\",\n\"PartAStatus\": \"Active\",\n\"PartBStatus\": \"Active\",\n\"PartADate\": \"02/01/2021\",\n\"PartBDate\": \"02/01/2021\",\n\"ExpiredDate\": null,\n\"MedicareReason\":\"\",\n\"APIResponseCode\": 0,\n\"APIResponseMessage\": \"Processed\",\n\"ProcessedWithError\":false,\n\"address\": {\n \"city\": \"City\",\n \"state\": \"MD\",\n \"street\": \"310 main\",\n \"zip\": \"12345\"\n },\n\"recordCount\": \"1\",\n \"score\": \"96\"\n}\n\npVerify has two RESTful API end points to provide MBI information, a POST and a GET call. The POST call will attempt the MBI inquiry and will get a real-time response with information related to the MBI inquiry. The GET call can be used optionally to retrieve that same response from our database.
\nThe workflow is:
\nGet Token via Token call.
\nCall MBIInquiry and pass the token along with demographic information.
\nOptionally use the GET call to retrieve the POST response.
\nNote** : Same Token can be used in subsequent inquiries.
\n","_postman_id":"b1971619-bedc-4cba-b32f-4097bd12e70f"},{"name":"pDV - Patient Demographic Validator","item":[{"name":"PatientFinderInquiry","id":"4912a49d-88ad-44f1-88bb-abd1bf1c716c","protocolProfileBehavior":{"disableBodyPruning":true},"request":{"method":"POST","header":[{"key":"Authorization","value":"Bearer {{access-token}}","type":"text"},{"key":"Client-API-Id","value":"{{client-api-id}}","type":"text"},{"key":"Content-Type","value":"application/json","type":"text"}],"body":{"mode":"raw","raw":"{\r\n\t\"FirstName\": \"firstname\",\r\n\t\"MiddleName\": null,\r\n\t\"LastName\": \"lastname\",\r\n\t\"DOB\": null, // use format MM/DD/YYYY\r\n\t\"SSN\": null, // use format XXX-XX-XXXX\r\n\t\"PhoneNumber\": null,\r\n\t\"Address\": {\r\n\t\t\"AddressLine1\": \"Address1\",\r\n\t\t\"AddressLine2\": null,\r\n\t\t\"City\": \"City\",\r\n\t\t\"State\": \"ST\", // use abbreviation - CA for California\r\n\t\t\"ZipCode\": \"12345\"\r\n\t},\r\n\t\"Location\": \"Somewhere\",\r\n\t\"ReferenceNumber\": null // MRN etc\r\n}"},"url":"https://api.pverify.com/api/PatientFinderInquiry","description":"Description:
Returns only the top matching patient based on provided demographic information. This endpoint is optimized for use cases where only the most likely match is needed.
Use Cases:
Fast lookups for integrations where a single high-confidence match is sufficient.
Scenarios where presenting a list of potential matches is not required.
Behavior:
Returns a maximum of 1 patient record (the best match).
Uses match score to determine the top candidate.
Ideal for a specific patient match.
Headers
\n*Note: The Client-API-Id is required. Header keys are case sensitive.
\nDescription:
Returns all matching patient records based on the search criteria. This endpoint is intended for workflows that require presenting multiple potential matches for verification.
Use Cases:
Used in Patient Validator-Verification.
Behavior:
Returns all matched patient records that meet the criteria.
Headers
\n*Note: The Client-API-Id is required. Header keys are case sensitive.
\nReturns a list of all matched patients. All other response fields are the same as the PatientFinderInquiry endpoint.
\n","urlObject":{"protocol":"https","path":["API","PatientFinderInquiryResults"],"host":["api","pverify","com"],"query":[],"variable":[]}},"response":[],"_postman_id":"c1603c25-229f-4bc1-b79f-232b0723526b"},{"name":"GetPatientFinderResponse","id":"674339a2-8b66-444a-b461-53d49660afe0","protocolProfileBehavior":{"disableBodyPruning":true},"request":{"method":"GET","header":[{"key":"Authorization","value":"Bear {{access-token}}","type":"text"},{"key":"Client-API-Id","value":"{{client-api-id}}","type":"text"},{"key":"Content-Type","value":"application/json","type":"text"}],"url":"https://api.pverify.com/API/GetPatientFinderResponse/0","description":"This GET method will return complete response of PatientFinderInquiry endpoint. This call allows you to get the patient demographicverification result by a unique transaction ID.
\nGetPatientFinderResponse Request
\n*Note: The Client-API-Id header is required. Header keys are case sensitive.
\nA successful GetPatientFinderResponse call will have the same format as the Patient Finder Inquiry response (above).
\n","urlObject":{"protocol":"https","path":["API","GetPatientFinderResponse","0"],"host":["api","pverify","com"],"query":[],"variable":[]}},"response":[],"_postman_id":"674339a2-8b66-444a-b461-53d49660afe0"}],"id":"477ee60e-7ee6-4885-b41a-ace7b7a3aa29","_postman_id":"477ee60e-7ee6-4885-b41a-ace7b7a3aa29","description":""},{"name":"Claim Status Inquiry","item":[{"name":"ClaimStatusInquiry","id":"06a58c55-84f9-4fd7-b426-5ed126209025","protocolProfileBehavior":{"disableBodyPruning":true},"request":{"method":"POST","header":[{"key":"Authorization","type":"text","value":"Bearer {{access-token}}"},{"key":"Client-API-Id","type":"text","value":"{{client-api-id}}"},{"key":"Content-Type","type":"text","value":"application/json"}],"body":{"mode":"raw","raw":"{\r\n \"payerCode\": \"00001\", \r\n \"ProviderLastName\": \"lastname\",\r\n \"ProviderNPI\": \"1234567890\", \r\n \"ProviderFederalTaxId\": \"\",\r\n \"payerClaimNumber\": \"\",\r\n \"chargeAmount\": 732.87,\r\n \"serviceStartDate\": \"04/01/2020\",\r\n \"serviceEndDate\": \"04/01/2020\",\r\n \"subscriber\": {\r\n \"FirstName\": \"\",\r\n \"lastName\": \"lastname\",\r\n \"dob\": \"07/07/2010\",\r\n \"memberID\": \"memberID\",\r\n \"gender\" : null // or \"M\" or \"F\"\r\n },\r\n \"isPatientDependent\": false\r\n}","options":{"raw":{"language":"json"}}},"url":"https://api.pverify.com/API/ClaimStatusInquiry","description":"The ClaimStatusInquiry is the second step of the workflow for obtaining Claim status Information through pVerify. As demonstrated below, the ClaimStatusInquiry call takes in subscriber or dependent demographic information, along with the authorization token, and returns the claim status among other information. To use this or any other method, you must first generate a token via the Token endpoint (see above Token method).
\n*Note: The Client-API-Id header is required. Header keys are case sensitive.
\nNote: The ClaimStatusInquiry for dependents is the same for self. However, it uses different data parameters.
\nThe API Response Codes and there description are shown below.
\n","urlObject":{"protocol":"https","path":["API","ClaimStatusInquiry"],"host":["api","pverify","com"],"query":[],"variable":[]}},"response":[],"_postman_id":"06a58c55-84f9-4fd7-b426-5ed126209025"},{"name":"GetClaimStatusResponse","id":"9041cf59-2440-4e9d-9cf7-bb28071b0d53","protocolProfileBehavior":{"disableBodyPruning":true},"request":{"method":"GET","header":[{"key":"Authorization","type":"text","value":"Bearer {{access-token}}"},{"key":"Client-API-Id","type":"text","value":"{{client-api-id}}"},{"key":"Content-Type","type":"text","value":"application/json"}],"url":"https://apis.pverify.com/API/GetClaimStatusResponse/53","description":"This GET method is used to obtain the transaction result later using a unique request ID. Note: the data is deleted after 90 days.
\nA successful GetClaimStatusResponse call will have the same format as the ClaimStatusInquiry response (above).
\n","urlObject":{"protocol":"https","path":["API","GetClaimStatusResponse","53"],"host":["apis","pverify","com"],"query":[],"variable":[]}},"response":[],"_postman_id":"9041cf59-2440-4e9d-9cf7-bb28071b0d53"}],"id":"6c3e355f-ce49-4b7e-aaf0-384e94178971","description":"pVerify has several RESTful APIs to give Claim Status information, given subscriber or dependent It would be a two step work flow.
\nClaimStatus payer work flow
\nGenerate Token
\nCall ClaimStatusInquiry to submit a request to our queue to get the Claim Status
\nIn order to run a Claim Status call, it is first necessary to generate a token using the authorization call
\n","event":[{"listen":"prerequest","script":{"id":"3ba6eee3-47ae-4d04-a145-8cd037259c60","type":"text/javascript","exec":[""]}},{"listen":"test","script":{"id":"2fcdc49a-5ef5-4f84-8146-29c090183193","type":"text/javascript","exec":[""]}}],"_postman_id":"6c3e355f-ce49-4b7e-aaf0-384e94178971"},{"name":"Misc","item":[{"name":"GetAllPayers","id":"fa05fefa-0d58-43fb-9723-ef981bd7b7b9","protocolProfileBehavior":{"disableBodyPruning":true},"request":{"method":"GET","header":[{"key":"Authorization","value":"Bearer {{access-token}}"},{"key":"Client-API-Id","value":"{{client-api-id}}"},{"key":"Content-Type","value":"application/json"}],"url":"https://api.pverify.com/API/GetAllPayers","description":"Returns the list of current pVerify payers (pVerify payer code & pVerify Payer Name). Note backoffice (non-EDI) payers are denoted with a payer code prefix of BO. For example BO00018
\nGetAllPayers Request
\n*Note: The Client-API-Id header is required. Header keys are case sensitive.
\nGetAllPayers Response
\n","urlObject":{"protocol":"https","path":["API","GetAllPayers"],"host":["api","pverify","com"],"query":[],"variable":[]}},"response":[],"_postman_id":"fa05fefa-0d58-43fb-9723-ef981bd7b7b9"},{"name":"GetPayerStatus","id":"d5059b99-e009-4787-8413-598a5e56493f","protocolProfileBehavior":{"disableBodyPruning":true},"request":{"method":"GET","header":[],"url":"https://api.pverify.com/api/GetPayerStatus","description":"This GET call will return the status of all pVerify payers. You can call this endpoint with an optional parameter of payerStatus and it will return payers from that status. By default the endpoint returns all payers and statuses. This API call does not require authentication.
\nGetPayerStatus Request
\nURL Parameter payerStatus value and description
\nGetPayerStatus Response
\n","urlObject":{"protocol":"https","path":["api","GetPayerStatus"],"host":["api","pverify","com"],"query":[],"variable":[]}},"response":[],"_postman_id":"d5059b99-e009-4787-8413-598a5e56493f"},{"name":"Down Payer List","id":"9aca240b-585d-4eb9-a600-24dbda1a5b5a","protocolProfileBehavior":{"disableBodyPruning":true},"request":{"method":"GET","header":[],"url":"https://api.pverify.com/API/GetPayerStatusStatistics?status=Rejected&checkForLastNumberOfHours=1","description":"This API will return an array of payers that are known to be temporarily down.
\n","urlObject":{"protocol":"https","path":["API","GetPayerStatusStatistics"],"host":["api","pverify","com"],"query":[{"key":"status","value":"Rejected"},{"key":"checkForLastNumberOfHours","value":"1"}],"variable":[]}},"response":[],"_postman_id":"9aca240b-585d-4eb9-a600-24dbda1a5b5a"}],"id":"950201fb-da4f-4724-a690-c4094270e294","_postman_id":"950201fb-da4f-4724-a690-c4094270e294","description":""},{"name":"Tables","item":[],"id":"27234fd2-af03-46b9-9e6d-12612cafd044","description":"pVerify Payer Code List
Click here to view Payer List
This is the pVerify service type code list, please use the service type code (first column) in your eligibility queries. Common eligibility information is in service type code 30, Health Benefit Plan Coverage.
\nNOTE: Used only for EligibilityInquiry endpoint. Please see Practice Type Codes for Eligibility Summary.
\nThis is the pVerify Practice Types available in production for EligiblitySummary endpoints. Practice Types are built around Service Type Codes.
\nPractice Types available under test endpoint
\n","_postman_id":"27234fd2-af03-46b9-9e6d-12612cafd044"},{"name":"Widget / Eligibility and Estimates / CGX","item":[{"name":"Setup","id":"fd9a9e9a-bd27-4ed6-b376-8b7ab73e75e0","protocolProfileBehavior":{"disableBodyPruning":true},"request":{"method":"POST","header":[],"body":{"mode":"raw","raw":"{\r\n \"clientApiId\":\"xxxx-xxxx-xxxx-xxxx-xxxx-xxxx-xxxx\",\r\n \"clientSecret\":\"xxxxxxxxxxxxxxx\"\r\n}","options":{"raw":{"language":"json"}}},"url":"https://premium.pverify.com/Widget/Setup","description":"Step 1 - Generate setupId to load widget in iframe
\nSetupId will be required to load the widget in iframe. SetupId can be generated using Client ID and Client Secret. To generate SetupId, pass Client ID and Client Secret to following endpoint
[POST] https://premium.pverify.com/Widget/Setup
e.g.
{\n\"clientApiId\":\"xxxx-xxxx-xxxx-xxxx-xxxx-xxxx-xxxx\",\n\"clientSecret\":\"xxxxxxxxxxxxxxx\"\n}\n\nIt will generate a SetupId something like this XXXXxxXX-XXXX-XxXX-XxXX-XXxxXXXXxXX.
\nStep 2 - Load iframe with following URL with setupId
If you want to integrate Estimation widget, then set URL of iframe as shown below
https://premium.pverify.com/Component/EstimateInquiry?SetupId=setupId
If you want to integrate Eligibility widget, then set URL of iframe as shown below
https://premium.pverify.com/Component/ElgInquiry?SetupId=setupId
Details about SetupId
\n1.Need to generate SetupId for each transaction
\n2.SetupId is valid for 10 mins
\n","urlObject":{"protocol":"https","path":["Widget","Setup"],"host":["premium","pverify","com"],"query":[],"variable":[]}},"response":[],"_postman_id":"fd9a9e9a-bd27-4ed6-b376-8b7ab73e75e0"},{"name":"CGXInquiry - Estimates and Eligibility Combo","id":"f7a0707b-c7c9-4fee-a3c1-5d2a36097261","protocolProfileBehavior":{"disableBodyPruning":true},"request":{"method":"POST","header":[{"key":"Authorization","type":"text","value":"Bearer {{access-token}}"},{"key":"Client-API-Id","type":"text","value":"{{client-api-id}}"},{"key":"Content-Type","type":"text","value":"application/json"}],"body":{"mode":"raw","raw":"{\r\n\t\"PayerCode\": \"00192\", // this is pVerify's code - either use this or PayerName\r\n \"PayerName\": \"United HC\", // this is your mapped name mapped through our system - contact pVerify for more info\r\n\t\"MemberId\": \"1234\",\r\n\t\"PatientFirstName\": \"John\",\r\n\t\"PatientLastName\": \"Doe\",\r\n\t\"PatientDOB\": \"01/01/2000\",\r\n \"Location\": \"Brooklyn\",\r\n\t\"AppointmentType\": \"MRI Brain\", // this is a list of CPT codes in our system\r\n \"CPTList\": [ \"77001\", \"77002\"], // either this or ApptType is used\r\n\t\"MRN\": \"1234\",\r\n \"IsActiveSecondry\": false, // optional\r\n \"SelfPay\": false, // optional\r\n \"PracticeTypeId\": 25 // optional\r\n}"},"url":"https://api.pverify.com/api/CGXInquiry","description":"CGXInquiry is our combined Eligibility & Estimate endpoint.
\nNote that only a handful of items are required. This allows very quick and easy coding to get a response. The NPI is hard coded to use the default NPI. The location can use the first/default location. Pricing is based either on payer/location specific pricing or the medicare price. If the former, then the CPT codes need to be imported into pVerify. If the later, then the location needs to have the state/ZIP code set, and the default medicare % needs to be set from Premium (Admin Setup). It is possible when configured to use remit data to power this estimate. The eligibility call is the same as the EligibilitySummary call. Either the practice type can be set from the body or it will use the default practice type set by client.
\nHeaders
\n*Note: The Client-API-Id is required. Header keys are case sensitive.
\nEither PayerCode (preference) or your Payer Name mapped through our system can be used. The system will use the PayerCode if not empty.
\nLocation is optional, it will pull the default location if not set. The location is used to power the Medicare pricing which relies on Zip Code. To overrride this, set the ZipCode field. If the Location field is a location that does not exist, it will be created. Note if this happens, the first user in the system must be role ClientAdmin else the API will not set the user to the location correctly. If this happens then the API call fails.
\nEIther CPTList (string array) or AppointmentType (name) can be used. If both are present then CPTList will be used. This is used to pull the pricing and it's based on the following order.
\nIF CptLIst is used, then this is the pricing order in the system:
\nRemit Price (CPT/Payer specific) (based on EDI 835 data specific to client)
\nPayer & CPT specific custom pricing (from your imported fee schedule)
\nPayer & CPT specific medicare pricing (from your imported fee schedule)
\nCPT specific custom pricing (from your imported fee schedule)
\nMedicare custom pricing (from your imported fee schedule)
\nMedicare pricing (from CMS)
\nNote for #6 there is a client-wide medicare price that can be used to act as a multiplier for Medicare Pricing - it is set in Admin Profile from Premium.
\nIf Appointment list is used - the pricing is the same as above except remit pricing is not factored in.
\nResponse JSON:
\nStartFragment
\n{
\"requestId\": 299,
\"isDataError\": false,
\"errorMessage\": \" Location set by default location. \",
\"detailResponse\": {
\"preAuthStatus\": null,
\"paFrom\": null,
\"locationName\": null,
\"cptCode\": \"70553\",
\"co_ins_Percentage\": \"0\",
\"co_Pay\": \"225.00\",
\"deductible_remaining\": \"0.00\",
\"out_of_Pocket_remaining\": \"5470.00\",
\"estimatedAllowable\": \"391.93\",
\"EstPtResponsibilitywDeduc\": \"225.00\",
\"EstPtResponsibilitywoDeduc\": \"225.00\",
\"EstPtResponsibilityMessage\": \"\",
\"amountPayable\": \"225.00\"
},
\"eligibilityRequestID\": 13672,
\"elgStatus\": \"Active\",
\"elgResponseMessage\": null,
\"estimationId\": 0,
\"apiResponseCode\": 0,
\"apiResponseMessage\": \"Processed\"
}
pVerify’s Widgets
\nThis endpoint submits a Same/Similar request into our queue. Note that this is not real time, and either the postback URL must be used (to submit the response to), or the GetSameOrSimilarResponse endpoint must be called with the request ID.
\n*Note: The Client-API-Id is required in header. Header keys are case sensitive.
\nStep 1: Check the value of the API Response Code property. If the API Response Code is 3 (Pending) then the request is pending and the Request ID can be extracted.
\nStep 2: Save the data
\nNote: The Same or Similar API always returns API response code as 3 (pending)
\n","urlObject":{"protocol":"https","path":["API","SameOrSimilarInquiry"],"host":["api","pverify","com"],"query":[],"variable":[]}},"response":[],"_postman_id":"166db4e2-0a5f-4a5d-842e-0566ccf6de77"},{"name":"GetSameOrSimilarResponse","id":"45811fd0-051e-4658-a8d9-ce17e5cc5702","protocolProfileBehavior":{"disableBodyPruning":true},"request":{"method":"GET","header":[{"key":"Authorization","type":"text","value":"Bearer {{access-token}}"},{"key":"Client-API-Id","type":"text","value":"{{client-api-id}}"},{"key":"Content-Type","type":"text","value":"application/json"}],"url":"https://api.pverify.com/API/GetSameOrSimilarResponse/1033246","description":"Get Same or Similar Response Using Unique Request ID
\nThis call is used to get the transaction result later using a unique request ID.
\nNote: We purge this data after 90 days
\n*Note: The Client-API-Id header is required. Header keys are case sensitive.
\nNotes
\nAlways check for apiResponseCode property value before processing.
\nIf APIResponseCode is zero then look for ErrorMessage and Claims to process response.
\nA successful GetSameOrSimilarResponse will have the same format as the SameOrSimilarInquiry response.
\nThis returns a PDF report of the Same or Similar request.
\nNote two things:
\nThis GET method will return details URL with Same and Simialr Request ID as a parameter.
\nGetSameAndSimilarDetailsURL Request
\n*Note: The Client-API-Id header is required. Header keys are case sensitive.
\nGetSameAndSimilarDetailsURL Resposne
\nJSON Response
\n{
\n\"isDetailsURLGenerated\": true,
\n\"url\": \"https://premium.pverify.com/Details\",
\n\"errorMessage\": null
\n}
\n","urlObject":{"protocol":"https","path":["API","GetSameAndSimilarDetailsURL","{requestID}"],"host":["api","pverify","com"],"query":[],"variable":[]}},"response":[],"_postman_id":"71e79aa5-2411-4663-b80a-ab35753c41eb"}],"id":"27c1350f-031f-4b1a-986e-35f0ba49882e","description":"pVerify has two RESTful API end points to give Same or Similar HCPCS(L code) Status information,
\nThis workflow is:
\nGet Token via Token call,
\nCall SameOrSimilarInquiry and pass the token along with demographic information.
\nCall GetSameOrSimilarResponse/{requestId} later to get the results and pass the token.
\nNote : Same Token can be used in subsequent inquiries.
\n\nCredentials\nTo use these calls, you will need to set up an account and be given a username & password or client-api-id & client-secret. Please contact the pVerify team for this information.
\n","event":[{"listen":"prerequest","script":{"id":"113be2f2-006b-44fa-9fdc-ab5be9ffa275","type":"text/javascript","exec":[""]}},{"listen":"test","script":{"id":"b5845783-abc2-4194-b30c-eafb43eecb1a","type":"text/javascript","exec":[""]}}],"_postman_id":"27c1350f-031f-4b1a-986e-35f0ba49882e"},{"name":"CMN (Discontinued)","item":[{"name":"CMNInquiry","id":"deb9000d-6025-4c54-896c-dbd8a294be65","protocolProfileBehavior":{"disableBodyPruning":true},"request":{"method":"POST","header":[{"key":"Authorization","value":"Bearer {{access-token}}","type":"text"},{"key":"Client-API-Id","value":"{{client-api-id}}","type":"text"},{"key":"Content-Type","value":"application/json","type":"text"}],"body":{"mode":"raw","raw":"{\r\n\"memberId\": \"123456\",\r\n\"patientFirstName\": \"First Name\",\r\n\"patientLastName\": \"Last Name\",\r\n\"patientDOB\": \"Date of birth\",\r\n\"patientStateCode\": \"StateCode\",\r\n\"hcpcsCode\": \"A, B, E, or K code\",\r\n\"dosStart\": \"12/09/2020\", \r\n\"dosEnd\": \"12/09/2020\", \r\n\"location\": \"location Name\",\r\n\"callBackUrl\":\"http://www.test.com/api/PostData\"\r\n}","options":{"raw":{"language":"json"}}},"url":"https://api.pverify.com/API/CMNInquiry","description":"This endpoint submits a Same/Similar request into our queue. Note that this is not real time, and either the postback URL must be used (to submit the response to), or the GetSameOrSimilarResponse endpoint must be called with the request ID.
\n*Note: The Client-API-Id is required in header. Header keys are case sensitive.
\n** Response JSON Processing Steps **
\nStep 1: Check the value of the API Response Code property. If the API Response Code is 3 (Pending) then the request is pending and the Request ID can be extracted.
\nStep 2: Save the data
\nNote: The CMN API always returns API response code as 3 (pending)
\n","urlObject":{"protocol":"https","path":["API","CMNInquiry"],"host":["api","pverify","com"],"query":[],"variable":[]}},"response":[],"_postman_id":"deb9000d-6025-4c54-896c-dbd8a294be65"},{"name":"GetCMNResponse","id":"1b347d13-61e5-41cb-8523-2fd48804b9f3","protocolProfileBehavior":{"disableBodyPruning":true},"request":{"method":"GET","header":[{"key":"Authorization","value":"Bearer {{access-token}}","type":"text"},{"key":"Client-API-Id","value":"{{client-api-id}}","type":"text"},{"key":"Content-Type","value":"application/json","type":"text"}],"url":"https://api.pverify.com/API/GetCMNResponse/8","description":"This call is used to get the transaction result later using a unique request ID.
\nNote: We purge this data after 90 days
\n*Note: The Client-API-Id header is required. Header keys are case sensitive.
\nNotes
\nAlways check for apiResponseCode property value before processing.
\nIf APIResponseCode is zero then look for ErrorMessage and Claims to process response.
\nA successful GetSameOrSimilarResponse will have the same format as the SameOrSimilarInquiry response.
\nThis returns a PDF report of the CMN request.
\nNote two things:
\nThe endpoint is premium.pverify.com
\nAuthentication token is not used, instead pass your API ID and Secret.
\npVerify has two RESTful API end points to give CMN (A,B,E or K codes) Status information,
\nThis workflow is:
\nGet Token via Token call,
\nCall CMNInquiry and pass the token along with demographic information.
\nCall GetSameOrSimilarResponse/{requestId} later to get the results and pass the token.
\nNote : Same Token can be used in subsequent inquiries.
\nThe JSON Viewer URL
\nCredentials To use these calls, you will need to set up an account and be given a username & password or client-api-id & client-secret. Please contact the pVerify team for this information.
\n","event":[{"listen":"prerequest","script":{"id":"eba8cbf7-f0ff-4164-af37-a2b728bb9c57","type":"text/javascript","exec":[""]}},{"listen":"test","script":{"id":"f98acc59-38f9-48ea-a7b2-35118e96a0ba","type":"text/javascript","exec":[""]}}],"_postman_id":"464faab0-4916-4c36-a55a-49c2bd5b779a"},{"name":"SNF (Discontinued)","item":[{"name":"SNF Inquiry","id":"46dceae3-1110-459e-8aae-3c5235da393a","protocolProfileBehavior":{"disableBodyPruning":true},"request":{"method":"POST","header":[{"key":"Authorization","type":"text","value":"Bearer {{access-token}}"},{"key":"Client-API-Id","type":"text","value":"{{client-api-id}}"},{"key":"Content-Type","type":"text","value":"application/json"}],"body":{"mode":"raw","raw":"{\r\n \"PayerCode\":\"00007\",\r\n \"MemberId\":\"123456789A\",\r\n \"PatientFirstName\":\"firstName\",\r\n \"PatientLastName\":\"lastName\",\r\n \"PatientDOB\":\"01/02/1983\",\r\n \"PatientStateCode\":\"TX\",\r\n \"DOS\":\"07/22/2020\",\r\n \"Location\":null,\r\n \"CallbackURL\":null,\r\n \"MRN\":null\r\n}"},"url":"https://api.pverify.com/API/SNFInquiry","description":"The pVerify API for SNF is like Same or Similar in that it will not deliver a result instantly, instead the user is expected to call the GET method 1 minute later.
\nThis GET call is intended to retrieve the SNF response initiated by the SNFInquiry POST call. By adding the requestId received in the POST call, users can retrieve the SNFInquiry Response.
\n