Overview

pVerify’s Real-time Exchange System facilitates the secure exchange of healthcare Eligibility and related transactions, supporting one-to-one real-time transactions.

One-to-one real-time transactions require customers to post a request, via WCF to a designated URL address. Once a request is received by the Service an immediate response is sent for each request posted.

• URL for the Production Interactive Services endpoint:
https://www.pverify.net/ebsoap/SoapService.asmx
• URL for the Production Interactive Services WSDL location:
https://www.pverify.net/ebsoap/SoapService.asmx?WSDL

Below are the endpoints made available through pVerify web services:

ServiceDescriptionIndependent Methods (Does not require Unique ID)
VerifyEligibilityGiven subscriber info (name, member ID, etc), will return UniqueID used for dependent callsYes
GetEligibilitySummaryFULL
Returns demographics & payer info for ALL services
No (dependent on ID from VerifyEligibility)
VerifyEligibility returns status codes according to the below table:

 

VerifyEligibility Status Codes

Status CodeMeaning
10Processed–Inactive
11Processed-Active
12Processed-Patient Not Found
13Processed – Provide not on file
14Rejected by Payer
15Pending*
17Payer Connection Down
18Payer not found
20Transaction authentication error
21Missing required information
22Invalid format error
*: Status Code 15 ‘Pending’ is returned when the payer is non-EDI…pVerify uses manual process (phone/web-login) to get results or in some cases uses screen scraping technology to fetch the eligibility and benefits for such payers…the delay in getting the results can be anywhere from 1 min. to 12 hours based on payer and agreed terms. These ‘Delayed Payers’ have prefix of either BO or PL…you can either automatically refresh results using the Unique ID every few hours or have a ‘Get Pending Results’ button on your eligibility screen.

Security and Authorization

pVerify requires client authentication and authorization prior to allowing the request being processed. Authentication is a means used to verify your identity as a legitimate trading partner to pVerify. Authorization refers to those actions you are permitted to perform once you are authenticated.

pVerify allows access to the Real-time Exchange System through the use of a username and password. These must be requested from pVerify and are sent to you through a secure email system.

To authenticate with the pVerify system, use the provided username/password combination within the request within the XML tabs <UserID> and <Password>

Testing

To test the pVerify SOAP API, use the below URL with the call shown on the right. Note that 5 payers are supported in test environment, and are a ‘canned’ response, in that beyond the user/password and payerID, the call parameters are not parsed. The data returned is HIPAA compliant data from a real patient, to show you what the response would look like for that payer.

URL: https://www.pverify.net/SoapSamples/SoapSamples.asmx

To learn more about tools for testing pVerify’s SOAP Service, click here.

The following payers are supported in Test Mode:

Payer NamepVerify® Payer-ID
AETNA00001
United Healthcare00192
Medicare Part A & B00007
Ohio Medicaid00165
BCBS of Texas00220

Methods

The following operations are supported. For a formal definition, please review the Service Description.

The starting point for transactions is typically VerifyEligibility, the user inputs authentication (user/pass), and known information for the patient/subscriber (ie member ID, DOB, etc). Note that each payer has different required fields, call us to determine which payers need which field. The method returns a UniqueID which can be used for downstream calls.  This is because not all payers have an EDI and will require human intervention to get the eligibility data.

 

VerifyEligibility

 

From the methods given in the pVerify SOAP API, VerifyEligibility is the base method which will give a unique ID and Status of the Patients Eligibility. Thus, VerifyEligibility must be called first.

Usage of Methods Starting with pVerify Eligibility

Below is a table of the VerifyEligibility Method input parameters followed by an explanation of the output for the call.

 

ElementXML Data TypeRequiredValueDescription
VersionXsd:StringNValue : 3.0.1By Default it wil be 3.0.1
UserIDXsd:StringYAlphanumeric, up to 50 charactersUserID is assigned by pVerify. Used to
determine the account profile used to process the request.
PasswordXsd:stringYAlphanumeric, up to 50 charactersPassword is assigned by pVerify used to validate User identity.
PayerIDXsd:stringYAlphanumeric, up to 50 characterspVerfiy Payer ID(Insurance Company Code) for the request. Payer Id can be found from method GetPayerList()
Provider NPIXsd:stringYNumeric, 10 digits only.Provider ID provided by CMS
Provider Last NameXsd:stringY50 characters maximum. Overages will be truncated.Provider Last name
Provider First nameXsd:stringN50 characters maximum. Overages will be truncated.Provider First Name
ProviderPINXsd:StringNNeed to fill
ProviderTaxanomyXsd:StringNNeed to fill
VerificationTypeXsd:StringYEither S or DS-Self Verification, D- Dependent Verification
SubLastNameXsd:string++50 characters maximum. Overages will be truncated.
SubFirstNameXsd:String++50 characters maximum. Overages will be truncated.
SubMemberIDXsd:StringYUnique member identifier
SubSSNXsd:String++
SubscriberGroupNoXsd:String++
DependentLastNameXsd:String++
DependentFirstNameXsd:String++
DependentRelationshipXsd:StringN
PatientGenderXsd:StringNEither M or F or OM-Male, F-Female, O-Other
PatientDOBXsd:String++
IssueDateXsd:StringN
DOSFromXsd:StringY
DOSToXsd:StringY
BatchNameXsd:StringN
ServiceCodesXsd:StringY
SpecialtyXsd:StringN
LocationXsd:StringN
ApptDateXsd:StringN
ApptTimeXsd:StringN
NotesXsd:StringN

 

VerifyEligibility Output Specification:

 

ElementDescription
DescriptionStatus Code related description will be displayed here or any Exception messages
StatusCodeTransaction Status Codes and its description
10 = Processed–Inactive
11 = Processed-Active
12 = Processed-Patient Not Found
13 = Processed – Provide not on file
14 = Rejected by Payer
15 = Pending*
17 = Payer Connection Down
18 = Payer not found
20 = Transaction authentication error
21 = Missing required information
22 = Invalid format error
UniqueIDUnique ID for each transaction

 

 

 

GetEligibilitySummaryFull