pVerify API

 
Click Here to View the pVerify Rest API Page

URL

The URL is https://www.pverify.net/EBSOAP/soapservice.asmx

Authentication

Handled by a UserID and Password within the SOAP call, given by pVerify

 

Testing

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

The following payers are supported in Test Mode

  1. AETNA (pVerify® Payer-Id 00001)
  2. United Healthcare (pVerify® Payer-Id 00192)
  3. Medicare Part A & B (pVerify® Payer-Id 00007)
  4. Ohio Medicaid (pVerify® Payer-Id 00165)
  5. BCBS of Texas (pVerify® Payer-Id 00220)

For example for VerifyEligibility, send the request body below to URL https://www.pverify.net/SoapSamples/SoapSamples.asmx with content type text/xml.

Request body:

<?xml version=”1.0″ encoding=”utf-8″?>
<soap:Envelope xmlns:xsi=”http://www.w3.org/2001/XMLSchema-instance” xmlns:xsd=”http://www.w3.org/2001/XMLSchema” xmlns:soap=”http://schemas.xmlsoap.org/soap/envelope/”>
<soap:Body>
<VerifyEligibility xmlns=”http://pverify.net/”>
<Version>string</Version>
<UserID>string</UserID>
<Password>string</Password>
<PayerID>00001</PayerID>
<ProviderNPI>string</ProviderNPI>
<ProviderLastName>string</ProviderLastName>
<ProviderFirstName>string</ProviderFirstName>
<ProviderPIN>string</ProviderPIN>
<ProviderTaxanomy>string</ProviderTaxanomy>
<VerificationType>string</VerificationType>
<SubLastName>string</SubLastName>
<SubFirstName>string</SubFirstName>
<SubMemberID>string</SubMemberID>
<SubSSN>string</SubSSN>
<SubscriberGroupNo>string</SubscriberGroupNo>
<DependentLastName>string</DependentLastName>
<DependentFirstName>string</DependentFirstName>
<DependentRelationship>string</DependentRelationship>
<PatientGender>string</PatientGender>
<PatientDOB>string</PatientDOB>
<IssueDate>string</IssueDate>
<DOSFrom>string</DOSFrom>
<DOSTo>string</DOSTo>
<BatchName>string</BatchName>
<ServiceCodes>string</ServiceCodes>
<Specialty>string</Specialty>
<Location>string</Location>
<ApptDate>string</ApptDate>
<ApptTime>string</ApptTime>
<Notes>string</Notes>
</VerifyEligibility>
</soap:Body>
</soap:Envelope>

Response:

<?xml version=”1.0″ encoding=”utf-8″?>
<soap:Envelope>
<soap:Body>
<VerifyEligibilityResponse>
<VerifyEligibilityResult>
<UniqueID>7107576</UniqueID>
<StatusCode>11</StatusCode>
<Description>Processed – Active</Description>
</VerifyEligibilityResult>
</VerifyEligibilityResponse>
</soap:Body>
</soap:Envelope>

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.

Independent methods (does not require Unique ID)

ServiceDescription
VerifyEligibilityGiven subscriber info (name, member ID, etc), will return UniqueID used for dependent calls
GetEligibilityBenefitsGiven subscriber info, returns demographics and benefits

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.

 

Given a VerifyEligibility call, use the UniqueID in the response to do the subsequent calls:

 

Methods dependent on UniqueID (from VerifyEligibility)

CallDescription
GetEligibilityReportReturns unparsed eligibility report
GetDemographicsReturns just demographics
GetEligibilitySummary
Returns demographics & payer info for 1 service
GetEligibilitySummaryFULL
Returns demographics & payer info for ALL services
GetEligibilitySummaryInNet
Returns In network summary benefits
GetEligibilitySummaryOutNet
Returns Out network summary benefits
GetParsedEligibility
Returns demographics and eligibility status
GetParsedEligibilityPlus
Returns demographics copay, eligibility status
GetPremiumBenefits
Returns eligibility status & benefits summary
GetServiceNames
Returns a list of service names
GetVisitbyServiceType
Returns visit stats
VerifyIfPatientIsDependent
Use if you want to know if patient is dependent or subscriber

 

Additionally we have other utility calls:

 

Payer functions

ServiceDescription
getPayerListYou want a list of pVerify payers
getPayerSearchCriteria
You want to know what search criteria are required per payer