openapi: 3.0.1
info:
  title: pVerify Authentication Claim Status API
  description: Real-time healthcare insurance eligibility and revenue-cycle API. pVerify exchanges EDI 270/271 eligibility transactions, returns plan and benefit summaries, checks 276/277 claim status, lists supported payers, and estimates patient financial responsibility. All API calls require an OAuth2 bearer token obtained from the /Token endpoint and a Client-API-Id header.
  termsOfService: https://www.pverify.com/terms-of-use/
  contact:
    name: pVerify Support
    url: https://pverify.com/contact-support/
  version: '1.0'
servers:
- url: https://api.pverify.com
  description: Production
security:
- bearerAuth: []
  clientApiId: []
tags:
- name: Claim Status
paths:
  /API/ClaimStatus:
    post:
      operationId: claimStatus
      tags:
      - Claim Status
      summary: Real-time 276/277 claim status
      description: Posts a real-time 276 claim status inquiry and returns the current 277 processing state, dates, and amounts for a submitted claim.
      requestBody:
        required: true
        content:
          application/json:
            schema:
              $ref: '#/components/schemas/ClaimStatusRequest'
      responses:
        '200':
          description: OK
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/ClaimStatusResponse'
components:
  schemas:
    ClaimStatusResponse:
      type: object
      properties:
        requestId:
          type: string
        APIResponseCode:
          type: string
        APIResponseMessage:
          type: string
        claimStatusCategoryCode:
          type: string
        claimStatusCode:
          type: string
        claimStatusDescription:
          type: string
        totalClaimChargeAmount:
          type: string
        claimPaymentAmount:
          type: string
    Provider:
      type: object
      properties:
        firstName:
          type: string
        lastName:
          type: string
        npi:
          type: string
        pin:
          type: string
    Subscriber:
      type: object
      properties:
        firstName:
          type: string
        lastName:
          type: string
        dob:
          type: string
          description: Date of birth (MM/DD/YYYY).
        memberID:
          type: string
    ClaimStatusRequest:
      type: object
      required:
      - payerCode
      - provider
      - subscriber
      properties:
        payerCode:
          type: string
        provider:
          $ref: '#/components/schemas/Provider'
        subscriber:
          $ref: '#/components/schemas/Subscriber'
        claimNumber:
          type: string
        claimChargeAmount:
          type: string
        serviceStartDate:
          type: string
        serviceEndDate:
          type: string
  securitySchemes:
    bearerAuth:
      type: http
      scheme: bearer
      description: OAuth2 access token returned by the /Token endpoint.
    clientApiId:
      type: apiKey
      in: header
      name: Client-API-Id
      description: Client API identifier issued by pVerify, required on all API calls.