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 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.The URL is https://api.pverify.com/APIBelow are the endpoints made available through pVerify web services:

EndpointHTTP MethodDescription
/API/TokenPOSTObtain authorization to pVerify Rest API
/API/EligibilityInquiry/POSTFacilitate the secure exchange of healthcare Eligibility and related transactions
/API/GetEligibilityResponse/{id}GETGet Eligibility Verify Result by Unique Transaction Id
/API/GetPayersGETGet pVerify payer list

 

 

 

Client Libraries
To simplify authorization and access to the pVerify API, we provide client libraries in C#. These libraries offer full access to the pVerify API with a minimum of code.

 

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.

Token

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.

Token Authorization 
HEADER
MethodPOST
URLhttps:// www.pverify.net/TestEligibilityRest/Token
Content-Typeapplication/x-www-form-urlencoded
URL ParamsNone
BODY
Data Params“username=” + username + “&password=” + password + “&grant_type=password”
The /Token response includes the following fields:
FieldTypeDescription
access_token{string}Authorization token unique to you which is used to verify your authorization for subsequent calls.
token_type{string}this is the token type which will be included before the access token in your subsequent method calls
expires_in{int}This is the amount of time that your token is valid for (in seconds)


Available API Endpoints
EligibilityInquiry
The EligibilityInquiry endpoint is the main method used get an eligibility report for a specific subscriber / dependent. This requires 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. To use this or any other method, you must first generate a token via the Token endpoint (see above Token method).

An example of a successful authorization response can be found in the code to the right. Please note you MUST use the pVerify payerCode. We also recommend passing the payer name.

Also note the body of the EligibilityInquiry is populated differently depending on if it is a subscriber query or a dependent query. See examples to the right.

EligibilityInquiry 
URLhttps://www.pverify.net/TestEligibilityRest /API/EligibilityInquiry
MethodPOST
HEADER
Authorization:Token from Step 1 Above (if you are using Postman be sure to put Token Type (‘Bearer’) before the token.
Client-User-Name:Username from step one
Client-Password:Password from step one
Content-Type:application/json
BODY
Data ParamsSee examples (right)
EligibilityInquiry request fields

The EligibilityInquiry request includes the following fields:

Required

Conditional

Property NameData TypeRequiredDescription

PayerCode

StringYespVerify payer Code (i.e. Aetna 0001)
PayerNameStringNoPayer Name
Provider.FirstNameStringNoProvider first name

Provider.LastName

StringYesProvider last name

Provider.NPI

StringYes10-digit NPI value
Provider.PINStringNoPIN
Provider.TaxonomyStringNoTaxonomy

Subscriber.FirstName

StringCondtionalFirst Name of subscriber required for self inquiry

Subscriber.LastName

StringCondtionalLast Name of subscriber required for self inquiry

Subscriber.MemberId

StringYesMember Id required for both type inquiries(self,dependent)

Subscriber.DOB

StringConditionalRequired for self-inquiry for better matching result .Format is MM/dd/yyyy
Subscriber.SSNStringNoSSN of subscriber

isSubscriberPatient

StringYesTrue for self and False for Dependent inquiry

doS_StartDate

StringYesDate of service start date in MM/dd/yyyy format

doS_EndDate

StringYesDate of service end date in MM/dd/yyyy format

serviceCodes

String ArrayYesServices codes to run inquiry. If no service codes are passed then service code 30 will be assigned.

requestSource

StringYesthe request Source for ex: RestAPI

Dependent

ObjectConditionalRequired for dependent inquiry
EligibilityInquiry response fields
The EligibilityInquiry response includes the following fields
NameTypeDescription
payerCode StringpVerify Payer Code
payerNameStringpVerify payer name
npiStringUnique National Provider Identifier Number
dobStringDate of Birth
relationshipWithSubscriberStringDependent relationship to client
isSubscriberPatientStringDetermines if patient in question is subscriber to plan
doS_StartDateStringDate stating start of services
doS_EndDateStringDate stating final end of services
serviceCodesStringtwo-digit codes placed on claims to indicate the setting in which a service was provided
placeOfServiceStringSetting in which service was provided
batchStringSection from which data came
appointmentTypeStringDescription of appointment scheduled
clientPayerMapCodeStringa string representing a description of the source ICD-9 code for the payer
clientProviderMapCodeStringa string representing a description of the source ICD-9 code for the provider
referenceIDStringCode associated with form submission
locationStringLocation of form submitted
elgRequestIDintIdentification of Eligibility Request
clientIDintIdentification of client
clearingHouseIDintIdentification of clearing house
clearingHousePayerCodeStringCode associated with clearing house Payer
clearingHousePayerNameStringName associated with clearing house payer
PayerNameStringName of company satisfying the claim.
payerFormatString?
payerIDintUnique ID associated with payer
isOBAMAcarebooleanDetermines if client is using Obama Care
providerIDintUnique ID associated with provider
statusStringThe stage that the transaction is in the process
transactionMessageStringAdditional information regarding the transaction
searchCriteriaIDintCode associated with provider across all available providers
repairNotesString?
createdByStringName associated with whomever initiated the transaction
createdOnStringDate transaction was created
clientLocationIDint?
requestSourceStringWhere the request came from
VerificationTypeStringSpecifies how a user is to have their identification verified
DOSStringDate that an individual received medical treatment
PlanStringDenotes the health care plan that the individual has
ExceptionNotesStringNotes concerning exceptions to the above fields
AdditionalInformationStringAny further information
OtherMessageStringFurther information
LabelStringName denoted for the current eligibility period
EffectiveFromDateStringDate which eligibility period began
ExpiredOnDateStringDate which eligibility plan expired
KeyStringObject associated with its following Value
ValueStringReturned value for given object
MessageStringAny additional information regarding the Key and Value fields
IdentifierStringHow the following information is flagged

Get Eligibility Response
This GET method is similar to the Eligibility Inquiry except that it is a GET call with the transaction ID as a parameter. This call allows you to get the eligibility verification result by a unique transaction ID. It is designed for use with non-EDI payers which require human intervention and are thus time deleyed in the response.

GetEligibilityResponse  
URL:https://www.pverify.net/TestEligibilityRest/API/
GetEligibilityResponse/{id}
Method:GET
HEADER
Authorization:Authorization token from above preceded by the String "Bearer"
Client-User-Name:Username from step 1.
Client-Password:Password from step 1
Body:This endpoint has no body.
A successful Get Eligibility Response will be the same as the Eligibility Inquiry response (above).

Get Payer List
Returns the list of pVerify payers (pVerify payer code & pVerify Payer Name)

GetPayer 
URL:/API/GetPayers
Method:GET
Headers:
AuthorizationBearer access_token
Client-User-Name:Username from step 1.
Client-Password:Password from step 1.
Content-Type:application/json
URL ParamsNone
Data ParamsNone

 

Get Pending Inquiries
This 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.

GetPendingInquiries 
URL:https://www.pverify.net/TestEligibilityRest/API/GetPendingInquiries/
Method:GET
Header:
AuthorizationAuthorization token from above preceded by the String "Bearer"
Client-User-NameUsername from step 1
Client-PasswordPassword from step 1
URL Params:DOS (format is MM-DD-YYY)
Data Params:None

Cancel Transactions
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 patient’s visit.

Cancel Transaction 
URLhttps://www.pverify.net/TestEligibilityRest /API/CancelTransaction
MethodPOST
Headers:
AuthorizationBearer followed by access token from above
Client-User-NameUsername provided by pVerify
Client-PasswordPassword provided by pVerify
Data Params{
"transactionId":12345455
}

Testing
Testing can be done in a HIPAA compliant manner by using the below endpoints with one of a small list of payers. This combination of endpoint and payer will give a response with same format as a normal patient, but in a HIPAA complaint manner for testing purposes.API URL : https://www.pverify.net/TestEligibilityRestHelp URL : https://www.pverify.net/TestEligibilityRest/helpTest user / password: pverify_demo / pverify@949

Test Payer list:
a ) AETNA (pVerify® Payer-Id 00001)
b ) United Healthcare (pVerify® Payer-Id 00192)
c ) Medicare Part A & B (pVerify® Payer-Id 00007)
d ) Ohio Medicaid (pVerify® Payer-Id 00165)
e ) BCBS of Texas (pVerify® Payer-Id 00220)

For examples, click the endpoint of interest on the table of contents (left) and view the example on the right.


Payer Table
This is the pVerify payer code list, please use the payer code (first column) in your eligibility queries.
Payer CodePayer Name
00283AARP (A United HealthCare Insurance Company)
00344Absolute Total Care
BO00018ACCESS IPA
000903Access Medicare
000947ACS Benefit Services
00468Administrative Services Inc
BO00013Advanced Primary Care Net
00345Advantage by Bridgeway Health Solutions
00346Advantage by Buckeye Community Health Plan
00347Advantage by Managed Health Services
00348Advantage by Superior HealthPlan
BO00123Advantica
00292ADVANTRA (TEXAS, NEW MEXICO, ARIZONA ONLY)
00001Aetna
000936AETNA BETTER HEALTH (IL)
000937AETNA BETTER HEALTH (KY)
000938AETNA BETTER HEALTH (LA)
000939AETNA BETTER HEALTH (MI)
000940AETNA BETTER HEALTH (MO)
000941AETNA BETTER HEALTH (NE)
000942AETNA BETTER HEALTH (NJ)
000943AETNA BETTER HEALTH (PA)
000944AETNA BETTER HEALTH (TX)
000945AETNA BETTER HEALTH (TX) CHIP
000946AETNA BETTER HEALTH (WV)
000935AETNA BETTER HEALTH VIRGINIA
00010Aetna Long Term Care
000948Affinity Essentials
00349Affinity Health Plan
00469Affinity Health Plan Medicare
000949AFLAC
00011AFLAC - Dental
00470AFLAC - Medicare Supplemental
00012Aftra Health Fund
000950AGIA INC
00013Alabama Medicaid
00459Alameda Alliance Health Plan
000951Alaska Medicaid
BO00062Alicare Multiplan
00635All Savers Life Insurance
00471Allegiance Benefit Plan Management
00636Allied Benefit Systems
BO00024ALTAMED HEALTH SERVICES
00014Altius Health Plans
00670Ambetter Superior Health Plan
00015AMC - Alaska Electrical Health & Welfare Fund
00016AMC - Health Future
00017AMC - Poly America
00018AMC - Touchstone
00019AMC - Touchstone PSO
00637Ameriben
000918American Behavioral Benefit Managers
00020American Community Mutual
00316American Family Insurance Group - Medicare Supplemental and PPO Policies
00021American General Life and Accident
00467American Health Medicare
00412American National Insurance Company
00413American National Life Insurance Company of Texas
00022American Postal Workers Union (APWU)
00023American Republic Insurance Company (ARIC)
MD002American Republic Insurance Company (ARIC)
00350American Retirement Life Insurance Company Medicare Supplement
00024AmeriChoice of New Jersey (Commercial)
00025AMERIGROUP
000929AmeriHealth
00460AmeriHealth Administrators
00351AmeriHealth Mercy Health Plan
BO00061Amerisure
00026Ameritas Life
BO00033Angeles IPA
00352Antares
BO00028APPLECARE MEDICAL GROUP
00461Arbor Health Plan (Only Nebraska Area)
00027Arizona Medicaid (AHCCCS)
00205Arizona Physician's IPA
00028Arkansas Medicaid
BO00026ASSOCIATED HISPANIC PHYS.
00120ASSURANT HEALTH-JOHN ALDEN LIFE
00188ASSURANT HEALTH-TIME INSURANCE
00191ASSURANT HEALTH-UNION SECURITY
00411Asuris Northwest Health
BO017ATRIO HEALTH PLANS
00318Aultcare
BO001800Avera Health BO
000896Avera Health Plan
00206AvMed Health Plans
BO001830Bankers Fidelity
BO00063Bankers Life And Casualty
000926Bankers Life And Casualty - EDI
00472Banner Health Plans
000931BCBS ANTHEM VIVITY
00462BCBS Of Alabama (Institutional)
00029BCBS of Arizona
00030BCBS of Arkansas
00330BCBS of Central New York
00031BCBS of Connecticut
00032BCBS of Georgia
00463BCBS Of Hawaii
00033BCBS of Illinois
00034BCBS of Indiana
00036BCBS of Kentucky
00037BCBS of Louisiana
00038BCBS of Maine
00039BCBS of Michigan (Thru BLUE EXCHANGE)
00040BCBS of Minnesota
00041BCBS of Mississippi
00042BCBS of Missouri
00475BCBS of Montana
00043BCBS of Nevada
00044BCBS of New Hampshire
00045BCBS of New Jersey (Horizon)
00046BCBS of New Mexico
00047BCBS of New York (Empire)
00465BCBS of New York (Excellus)
00311BCBS of North Dakota
00048BCBS of Ohio
00454BCBS of Oklahoma
00049BCBS of Oregon (Regence)
00050BCBS of Pennsylvania (Highmark)
00476BCBS of Pennsylvania (Highmark) [Institutional]
00051BCBS of Rhode Island
00308BCBS of the Rochester Area (NY)
00309BCBS of Utica-Watertown (NY)
00477BCBS of Vermont
00052BCBS of Virginia
00331BCBS of West Virginia
00325BCBS of Western New York
00053BCBS of Wisconsin
00312BCBS of Wyoming
BO008Beechstreet
00478Benefit Management Inc
00419Best Choice Health Plan
00054Best Life and Health
00055Better Health Plans (Unison Health Plan)
00207Blue Cross Blue Shield Alabama (Commercial)
00209Blue Cross Blue Shield Alaska (Premera)
00210Blue Cross Blue Shield Colorado
00282Blue Cross Blue Shield Delaware (Carefirst)
00288Blue Cross Blue Shield District of Columbia (Carefirst)
00211Blue Cross Blue Shield Florida
00212Blue Cross Blue Shield Iowa (Wellmark)
00213Blue Cross Blue Shield Kansas
00306Blue Cross Blue Shield Kansas City
00289Blue Cross Blue Shield Maryland (Carefirst)
00214Blue Cross Blue Shield Massachusetts
00215Blue Cross Blue Shield Nebraska
00216Blue Cross Blue Shield North Carolina
00217Blue Cross Blue Shield South Carolina
00218Blue Cross Blue Shield South Dakota (Wellmark)
00219Blue Cross Blue Shield Tennessee
00220Blue Cross Blue Shield Texas
00002Blue Cross of California
00056Blue Cross of Idaho
00479Blue Cross of Idaho
00057Blue Cross of Northeastern Pennsylvania
00221Blue Cross Washington (Premera)
S001Blue Exchange
00003Blue Shield of California
00480Blue Shield of North Eastern New York
00058Blue Shield of Washington (Regence)
00284BlueChoice HealthPlan South Carolina Medicaid
00290Bluegrass Family Health
00399BMC HealthNet Plan
00420Boon-Chapman Benefit Admin
00222Bravo Health, Inc.
000952BRIDGESPAN
00353Bridgeway Arizona
BO00027BRIGHT HEALTH PHYSICIANS/
00354Buckeye Community Health
00059California Medicaid (Medi-Cal)
00060Capital Blue Cross (Pennsylvania)
00328Capital District Physicians Health Plan (CDPHP)
BO00023CAPMN
00482CAPROCK
00891Care Improvement Plus
BO00098Care Improvement plus (BO)
00638Care1st Health Plan Arizona
00639Care1st of California
00671CareMore Health Plan
00223CarePlus Health Plan
00224CareSource Health
00061Cariten Healthcare
BO00025CARMO
00483Carolina Care Plan, Inc. (CCP)
00355Carpenters' Health and Welfare Trust Fund of St. Louis
BO00036CBCA Administrators
00414CeltiCare
00356Cenpatico - Arizona
00357Cenpatico - Florida
00358Cenpatico - Georgia
00359Cenpatico - Indiana
00360Cenpatico - Kansas
00415Cenpatico - Massachusetts
00640Cenpatico - Missouri
00361Cenpatico - Ohio
00362Cenpatico - South Carolina
BO00134Central Health Plan
00225Central Reserve Insurance Company
00363Central Reserve Life Insurance Company Medicare Supplement
00315Central States Fund
00063CHAMPVA/Spina Bifida/Children of Women Vietnam Vets
00313CHC - Coventry Health Care Federal
0009110CHC - Illinois
00314CHC - Vista (MCD, FHK, LTC)
00366CHC FLORIDA/VISTA/SUMMIT
00064CHC of Delaware
00065CHC of Georgia
00066CHC of Iowa
00067CHC of Kansas
00068CHC of Louisiana
00069CHC of Nebraska
000907CHC OmniCare (Michigan)
00228CHCCARES-SOUTH CAROLINA
00653Christian Brothers Service
00004Cigna
BO00037CNIC
BO018Colonial Penn Insurance
000910Colonial Penn Life
00894Colonial Penn Life
00070Colorado Access
00071Colorado Medicaid
00421Columbia United Providers
00072Community Care of Oklahoma
00641Community Health Group
00291Community Health Plan of Washington
00422Community HealthFirst Medicare (CHF Medicare Advantage)
00423ConnectiCare
00073Connecticut Medicaid
00226Continental General Insurance Company
00364Continental General Insurance Company Medicare Supplement
00501Continental Life-Aetna
00074Cooperative Benefit Administrators (CBA)
00076CoreSource (FMH)
00077CoreSource (Little Rock)
00078CoreSource (MD, PA, IL)
00080CoreSource (OH)
00424Corporate Benefit Service
MD001Country Life Insurance Company
00082Coventry Advantra Freedom
00229COVENTRY ADVANTRA SAVINGS
00083Coventry Health and Life (Oklahoma)
00293COVENTRY HEALTH AND LIFE-NEVADA
00084Coventry Health Care Carelink (Advantra)
00085Coventry Health Care Carelink Medicaid
00086Coventry Health Care Carenet
000933COVENTRY HEALTH CARE CAROLINAS WELLPATH
00227COVENTRY HEALTH LIFE-TN ONLY
00087Coventry Healthcare National Network
00294COVENTRY MISSOURI
00365Coventry Nebraska Medicaid
00367COVENTRYCARES
000904CoventryCares of Michigan
00295COVENTRYONE
00368CSA Fraternal Live Medicare Supplement
BO003Culinary Health Fund (back-office)
00425DakotaCare
BO001801Dakotacare BO
BO077Delaware MAP
00455Delaware Medicaid
000920Dell Childrens Health Plan
PL003Delware Medical Assistance Program
00426Denver Health Medical Plan
00427Deseret Mutual (DMBA)
000701Desert Mutual
BO010Dialysis Verification
00088Diamond Plan (Maryland Medicaid)
00089Director's Guild
00231District of Columbia Medicaid
BO00137Easy Choice Health Plan
00643EBMS
00642Elderplan Inc
BO019Emblem Health Plan
BO00053EMBLEM HEALTH(BO)
000101EMBLEM HEALTH-EDI
000954EMPLOYEE BENEFIT MANAGEMENT SYSTEM (EBMS)
00403Essence Healthcare
BO00124Eye Quest
BO9001Eyefinity
00092Fallon Community Health Plan
00428FamilyCare
00644FCE Benefit Administrators
BO00020FCS01
00093Federated Insurance Company
BO00125FHHS
00329Fidelis Care New York
00094First Ameritas of New York
BO000995First Choice Health
000917First Community Health Plans
000932First Health
BO006First Health (various plans)
09001First Health Life
BO00059First Priority Hlth
00096First Reliance Standard Life
BO00039First United American Life
PL002Fiserv Health
00645Florida Health Care Plans
00429Florida Hospital Healthcare System
00098Florida Medicaid
BO00126FMH
00319Freedom Blue
00404Fresenius Medical Care
000919Gateway Health Plan
00458Geisinger Health Plan
00405Generations Healthcare
00100Georgia Medicaid
BO00040GHI/Emblem(BO)
00430Gilsbar
00646Gold Coast Health Plan
00647Golden Rule Insurance
00101Government Employees Hospital Association (GEHA)
00369Great American Life Assurance Company Medicare Supplement
00370Great American Life Insurance Company Medicare Supplement
00264GROUP & PENSION ADMINISTRATORS
00486Group Health Co-Operative
BO000992Group Health Plan
00103Group Health Plan (GHP)
00371Group Practice Affiliates
BO00041Group Resources
BO00042Guardian
00102GWH-CIGNA
00909Harken Health
00372Harmony Health Plan (WellCare of Florida)
00104Harvard Pilgrim Health Care
00232Hawaii Medicaid
00484Hawaii Medical Service Assoc (HMSA)
BO00093Health Alliance
00105Health Alliance Medical Plan (HAP)
00648Health Alliance Medical Plan (IL)
BO00065Health America Advantra
BO00058Health America Of Pennsylvania
000901Health America Of Pennsylvania
00233Health Choice Arizona
00649Health Choice Oklahoma
000924HEALTH FIRST HEALTH PLAN
000925HEALTH FIRST INSURANCE
00431Health Net Medi-Cal
00005Health Net National
00006Health Net of Northeast
00601Health New England Eligibility Standard
00317Health Partners (Minnesota)
00106Health Partners of Philadelphia
00432Health Plan of San Mateo
BO00084Health Plans Inc.
00107HealthAmerica And HealthAssurance
00108HealthCare Inc. (Promina)
000955HEALTHCARE MANAGEMENT ADMIN
BO00043Healthcare Partners
BO00054HEALTHCARE PARTNERS/HERITAGE
00332Healthcare Solutions Group
00109HealthCare USA (HCUSA)
00373HEALTHe Exchange
00374HealthEase (WellCare of Florida)
00375HealthEase Kids (WellCare of Florida)
00110Healthfirst New York
00234Healthfirst of New Jersey
00137HealthMarkets: Chesapeake National Life Insurance
00136HealthMarkets: Mega Life and Health
00138HealthMarkets: Mid West National Life Insurance
00140HealthMarkets: Transamerica Life Insurance
00326Healthnow
00651HealthPlan of Nevada
000957HEALTHPLANS INC
BO00044HealthPlus
00111HealthPlus of Michigan
00652HealthScope
00280HealthSmart Benefit Solutions
00333HealthSpring
00342HealthSpring Life & Health Insurance Company
00338HealthSpring of Alabama
00341HealthSpring of Florida
00340HealthSpring of Illinois
00339HealthSpring of Tennessee
00235HIPNY
00433Hometown Health
BO00060HOP
00297Horizon New Jersey Health
00112Humana
00434Humana of Florida
00113Idaho Medicaid
000632IEHP Direct
BO00092IEHP Direct Health Plan
00114Illinois Medicaid
00435Independence Administrators
00115Independence Blue Cross (Pennsylvania)
00436Independent Health
00116Indiana Medicaid
000916Indiana University Health Plan
00236Inland Empire Health
BO013Innovante
00376Integrated Mental Health Services
BO00045International Services
00117InterValley Health Plan
00118Iowa Medicaid
00237Jackson Memorial Hospital Health Plan
00437John Hopkins Health Plan
00265JP FARLEY CORPORATION
00121Kaiser Foundation Health Plan of Colorado
00122Kaiser Foundation Health Plan of Hawaii
00123Kaiser Foundation Health Plan of Ohio
00124Kaiser Foundation Health Plan of the Mid-Atlantic
00125Kaiser Foundation Health Plan of the Northwest
00126Kaiser Permanente of Georgia
00127Kaiser Permanente of Northern California
00488Kaiser Permanente of Southern California
00128Kansas Medicaid
00129Kentucky Medicaid
00654Key Benefit Administrators (KBA)
00377Keystone Mercy Health Plan
00438Kitsap Physician Services
BO00031LAMC IPA
00655Lifewise Health Plan of Oregon
00634LOCAL 1199
BO00046Local 272 welfare Fund
00474Louisiana Health Exchange
00130Louisiana Medicaid
00238Lovelace Health Plan
00378Loyal American Life Insurance Company Medicare Supplement
BO00056MAGNACARE
00879Magnacare
00095MAIL HANDLERS BENEFIT PLAN
00656Maine Community Health Options
00239Maine Medicaid
00379Managed Health Services Indiana
00380Managed Health Services Wisconsin
BO001820Manhattan Life
00298Maricopa Care Advantage (Arizona)
00299Maricopa Health Plan (Arizona)
00132Maryland Medicaid
00133Massachusetts Medicaid
BO00082MASSHEALTH
00381MDWise Hoosier Alliance
000923MDWISE Medicaid Health Plans
00657MedBen
00439MedCost Benefit Services
00134Medica
00135Medical Mutual of Ohio
00007Medicare Part A and B
BO00047Medsolutions
00658MedStar Health Plan
00139Mega Life (Oklahoma City)
00243Mercy Care Plan (Arizona)
00334Mercy Health Care Plan
00902Meridian Health Plan of Illinois
00893Meritain Health
BO00048Meritian
00244MetLife Dental Family
BO00049Metroplus
00659MetroPlus Health Plan
00141Metropolitan Health Plan (MHP)
00245Michigan Medicaid
00440Michigan Medicaid Pending Eligibility
00246Michigan MIChild
BO00057Michigan Mutual
00240Mid Atlantic Medical Services, LLC (MAMSI)
00142Minnesota Medicaid
00267MISSISSIPPI ADMIN SERVICES, INC
00144Mississippi Medicaid
00145Mississippi State Employees and Teachers Health Plan
00146Missouri Medicaid
00147MMSI (Mayo Health)
BO000991MODA Health Plan
00148Molina Healthcare of California
00300MOLINA HEALTHCARE OF FLORIDA
00485Molina Healthcare of Illinois
00150Molina Healthcare of Michigan
00382MOLINA HEALTHCARE OF MISSOURI
00247Molina Healthcare of New Mexico
00151Molina Healthcare of Ohio
00152Molina Healthcare of Texas
00153Molina Healthcare of Utah
00154Molina Healthcare of Washington
00248Montana Medicaid
BO00064Monumental Life Insurance Co
BO009Motion Picture Industries
00320Mountain State
BO00016MPM10
00155Mutual of Omaha
00156MVP Health Care (New York)
00157National Association of Letter Carriers (NALC)
00158Nationwide Health Plan
BO00073Nationwide Mutual Insurance
00500NEHEN - Neighborhood Health Plans
00249Neighborhood Health Partnership
00502Neighborhood Health Plan RI
BO00083NETWORK HEALTH -BO
009012Network Health Insurance Corp
00466Network Health Plan of WI
00159Nevada Medicaid
BO00074New Era Insurance Company
000902New Era Insurance Company
00160New Hampshire Medicaid
00161New Jersey Medicaid
00162New Mexico Medicaid
00163New York Medicaid
BO00030NMM01
00164North Carolina Medicaid
00250North Dakota Medicaid
BONONEDInot supported yet
00441Nova Healthcare Administrators
00335NovaSys Health
00383Ohana Health Plan (WellCare of Hawaii)
00165Ohio Medicaid
00166Oklahoma Medicaid
00167OmniCare (Michigan)
000956OPERATING ENGINEERS LOCAL 428
BO015operating engineers welfare fund
BO000190Opticare
00310Optima/Sentara
00168Oregon Medicaid
00169Oxford Health Plans
BO00015PA513
00442Pacific Source Health Plan
00304PacifiCare (PPO)
00254PacifiCare of Arizona (HMO)
00008PacifiCare Of California
00255PacifiCare of Colorado (HMO)
00443PacifiCare of Nevada (HMO)
BO001Pacificare of Nevada [BackOffice]
00170PacifiCare Of Oklahoma
00251PACIFICARE OF OREGON
00252PACIFICARE OF TEXAS
00253PACIFICARE OF WASHINGTON
00660Pan-American Life Insurance
BO00014PAPER
000921Paramount Health Care
00444Partners National Health Plans of NC
00256Partnership Health Plan of California
00384Passport Advantage
00257Passport Health Plan
00385Peach State Health Plan
00171Pennsylvania Medicaid
000922PerformCare
00322Personal Insurance Administrators
00230PERSONALCARE
BO007PHCS
00307PHCS Savility Payers
00258Phoenix Health Plan
BO00019PHYSICIANS CARE
BO00095Physicians health choice
00172Physicians Mutual Insurance Company
00260Pittman and Associates
00173Preferred Health Systems
BO00032Preferred IPA
BO00022PREFERRED IPA OF CA
00261PreferredOne
BO00011Premier Eye Care
00661Premier Health
00662Prestige Health Choice
00321PrimeWest Health
00174Principal Financial Group (Nippon Life)
00175Principal Financial Group (Principal Life)
00324Priority Health
00268PROFESSIONAL BENEFITS ADMIN (IL)
00262Providence Health Plan
00386Provident American Life & Health Insurance Company Medicare Supplement
00445Public Employees Health Plan (PEHP)
00263Puerto Rico Medicaid (ODSI)
00663QualCare
00402Qualchoice
00387QuikTrip Corporation
BO00021REGAL
00176Reliance Standard Life
00270Rocky Mountain Health Plan
00271San Francisco Health Plan
00272San Joaquin Health Plan
BO001789Sanford Health BO
00400Sanford Health Plan
00446Santa Clara Valley Health and Hospital
00177SCAN HMO
00305Scott White Health Plan
00664Secure Health Plans of GA
BO00068Security Blue
00388Select Health of South Carolina
00447Select Health Utah
BO002Self Pay
BO00097Seton Health
000777Sharp Health Plan
00473Sierra Health Service
00091Significa Benefit Services
00665Simply Healthcare Plans
00666Soundpath Health
BO00029SOUTH ATLANTIC MED. GRP.
00273South Carolina Medicaid
00179South Dakota Medicaid
00180Southern Health Services (SHS)
00389Special Agents Mutual Benefit Association
00390SPJST Medicare Supplement
00181Standard Insurance
00182Standard Insurance of New York
MD003Standard Life and Accident Insurance
00416Standard Life and Accident Insurance Company
00183Star HRG
BO00070State Farm Health Ins
00897State Farm Ins
001908State Mutual (Lincoln Novation)
00391StayWell (WellCare of Florida)
00392StayWell Kids (WellCare of Florida)
BO00072Sterling Life Insurance (BO)
BO00001Stirling Benefits Inc
009201Stonebridge Life Insurance Company
BO011STTEC-Secure Horizons
00184StudentResources
00448SummaCare Health Plan
00327Sunshine State Health Plan
00393Superior HealthPlan Texas
BO00096Superior Vision
BO004Teachers Health Trust (back-office)
00185Tennessee Medicaid (TennCare)
00406TexanPlus - North Texas Area
00407TexanPlus - Southeast Texas Area
00275Texas CHIP
00186Texas Medicaid
BO00111Texas Medicaid BO
00667The Loomis Company
00187Three Rivers Health Plans (Unison Health Plan)
00408Today's Health
00409Todays Options
000953TRANSAMERICA LIFE INSURANCE HEALTHMARKETS
BO00067Travelers Insurance Company
00410Tribute / SelectCare of Oklahoma
00009Tricare
009502TRICARE for Life
009401Tricare West
BO00112Tricare-Pending
00189Trustmark Insurance
00190Tufts Health Plan
BO016UAW retirees medical benefits
00449Ucare of Minnesota
BO00050UMR
00417UMR Wausau
00269UNDERWRITERS SAFETY & CLAIMS
00303Unicare
00394Union Pacific Railroad Employes Health Systems
BO00069Unison Administrative Services
PL004UNISON MEDICAID
00192United Healthcare
UHG007United Healthcare - Optum Behavioral Solutions
UHC01United Healthcare Alternate
BO00075United Healthcare Community Plan
UHG002United Healthcare Community Plan Kansas
UHG003United Healthcare Community Plan Tennessee
UHG004United Healthcare Facets Detroit Community and State
UGH005United Healthcare Facets Pittsburgh Community and State
UHG006United Healthcare Nevada Market
UHG008United Healthcare SecureHorizons
UHG009United Healthcare Student Resources
UHG0010United Healthcare- West
00395United Teacher Associates Insurance Company Medicare Supplement
UHG001UnitedHealth Group - Community Plan
00277UnitedHealthcare Plan of the River Valley
00450Unity Health Plans
00451Univera
00193Universal Care of CA
00668University Care Advantage AZ
00278University Family Care
00296UNIVERSITY OF MISSOURI
00301University Physicians Care Advantage (Arizona)
00302University Physicians Healthcare Group (Arizona)
00452UPMC Health Plan (Tristate)
BO00051US Family Health Plan
00194USAA-Medicare Supplemental
00195VA Fee Basis Program
BO00066Valley Preferred
00396Vantage Health
00196Vermont Medicaid
00197Virginia Medicaid
00337Vista (MCD, FHK, LTC)
00336VIVA Health
00397VNS CHOICE
00279Vytra
00198Washington Medicaid
00453Washington Medicaid (ProviderOne)
00401WEA Trust
00398WEB-TPA, Inc.
BO00052Wellcare
00418WellCare Health Plans
BO012WellMed
00199Wellpath Select (Carolinas)
00200West Virginia Medicaid
00669Western & Southern Financial Group
00281Western Health Advantage
00201Wisconsin Medicaid
00286Wisconsin Medicaid Chronic Disease Program
00287Wisconsin Medicaid Well Woman Program
00202World Insurance (ARIC)
00203Writers Guild
00204Wyoming Medicaid
BO00055ZURICH
BO00071Zurich American Ins. Co.

Click Here to Download pVerify Payer Codes Excel Sheet

Service Code Table
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
Service Type CodeService Type Code Name
84Abortion
64Acupuncture
28Adjunctive Dental Services
85AIDS
57Air Transportation
AJAlcoholism
GYAllergy
79Allergy Testing
15Alternate Method Dialysis
13Ambulatory Service Center Facility
7Anesthesia
97Anesthesiologist
71Audiology Exam
10Blood Charges
91Brand Name Prescription Drug
B2Brand Name Prescription Drug - Formulary
B3Brand Name Prescription Drug - Non - Formulary
B1Burn Care
58Cabulance
87Cancer
BLCardiac
BGCardiac Rehabilitation
CQCase Management
78Chemotherapy
33Chiropractic
34Chiropractic Office Visits
16Chronic Renal Disease (CRD) Equipment
BDCognitive Therapy
3Consultation
C1Coronary Care
BCDay Care (Psychiatric)
37Dental Accident
35Dental Care
36Dental Crowns
DGDermatology
DSDiabetic Supplies
23Diagnostic Dental
5Diagnostic Lab
73Diagnostic Medical
4Diagnostic X-Ray
76Dialysis
63Donor Procedures
AKDrug Addiction
DMDurable Medical Equipment
12Durable Medical Equipment Purchase
18Durable Medical Equipment Rental
86Emergency Services
BPEndocrine
26Endodontics
ARExperimental Drug Therapy
BREye
CPEyewear And Eywear Accessories
82Family Planning
COFlu Vaccination
AMFrames
89Free Standing Prescription Drug
BNGastrointestinal
60General Benefits
GFGeneric Presciption Drug - Formulary
GNGeneric Presciption Drug - Non -Formulary
92Generic Prescription Drug
BTGynecological
30Health Benefit Plan Coverage
42Home Health Care
43Home Health Prescriptions
44Home Health Visits
45Hospice
47Hospital
53Hospital - Ambulatory Surgical
51Hospital - Emergency Accident
52Hospital - Emergency Medical
48Hospital - Inpatient
50Hospital - Outpatient
49Hospital - Room and Board
80Immunizations
BAIndependent Medical Evaluation
83Infertility
72Inhalation Therapy
ICIntesive Care
BSInvasive Procedures
61In-vitro Fertilization
AOLenses
59Licensed Ambulance Licensed Ambulance
54Long Term Care
BMLymphatic
90Mail Order Prescription Drug
BWMail Order Prescription Drug : Brand Name
BXMail Order Prescription Drug : Generic
55Major Medical
CMMammomogram, High Risk Patient
CNMammomogram, Low Risk Patient
BEMassage Therapy
69Maternity
27Maxillofacial Prosthetics
1Medical Care
56Medically Related Transportation
MHMental Health
CGMental Health Facility - Inpatient
CHMental Health Facility - Outpatient
CEMental Health Provider - Inpatient
CFMental Health Provider - Outpatient
62MRI/CAT Scan
NINeonatal Intesive Care
BQNeurology
65Newborn Care
AQNonmedically Necessary Physical
BINursery
BUObsterical
BVObsterical/Gynecological
ADOccupational Therapy
ONOncology
40Oral Surgery
38Orthodontics
BKOrthopedic
9Other Medical
77Otological Exam
BBPartial Hospitalization (Psychiatric)
66Pathology
BHPediatric
24Periodontics
88Pharmacy
AEPhysical Medicine
PTPhysical Therapy
BYPhysician Visit - Office : Sick
BZPhysician Visit - Office : Well
32Plan Waiting Period
19Pneumonia Vaccine
93Podiatry
95Podiatry - Nursing Home Visits
94Podiatry - Office Visits
17Pre-Admission Testing
74Private Duty Nursing
CBPrivate Duty Nursing - Home
CAPrivate Duty Nursing - Inpatient
96Professional (Physician)
A3Professional (Physician) Visit - Home
99Professional (Physician) Visit - Inpatient
A1Professional (Physician) Visit - Nursing Home
98Professional (Physician) Visit - Office
A0Professional (Physician) Visit - Outpatient
A2Professional (Physician) Visit - Skilled Nursing Facility
75Prosthetic Device
39Prosthodontics
A4Psychiatric
A7Psychiatric - Inpatient
A8Psychiatric - Outpatient
A5Psychiatric - Room and Board
A6Psychotherapy
PUPulmonary
BFPulmonary Rehabilitation
6Radiation Therapy
A9Rehabilitation
ABRehabilitation - Inpatient
ACRehabilitation - Outpatient
AARehabilitation - Room and Board
RNRenal
14Renal Supplies in the Home
RTResidential Psychiatric Treatment
46Respite Care
25Restorative
41Routine (Preventive) Dental
ANRoutine Exam
81Routine Physical
CLScreening Laboratory
CKScreening X - Ray
20Second Surgical Opinion
AGSkilled Nursing Care
AHSkilled Nursing Care - Room and Board
BJSkin
67Smoking Cessation
22Social Work
AFSpeech Therapy
AISubstance Abuse
CISubstance Abuse Facility - Inpatient
CJSubstance Abuse Facility - Outpatient
2Surgical
8Surgical Assistance
CDSurgical Benefits - Facility
CCSurgical Benefits - professional (physician)
21Third Surgical Opinion
TCTransitional Care
TNTransitional Nursery Care
70Transplants
UCUrgent Care
11Used Durable Medical Equipment
ALVision (Optometry)
68Well Baby Care
Click Here to Download pVerify Service Codes Excel Sheet** Service codes are located on the second page of sheet.

 

Click a endpoint in the left menu (for example “Token”) to get an example

 

Click a endpoint in the left menu (for example “Token”) to get an example

 

Click a endpoint in the left menu (for example “Token”) to get an example

 

Click a endpoint in the left menu (for example “Token”) to get an example

Note, these classes use both the OkHttp Java Library and The Okio Library both of which can be found here

 

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