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.
 
Below 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

Token
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.
 
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
 

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/TestEligibilityRest

 
Help URL : https://www.pverify.net/TestEligibilityRest/help

 
Test 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
283AARP (A United HealthCare Insurance Company)
344Absolute Total Care
BO00018ACCESS IPA
903Access Medicare
947ACS Benefit Services
468Administrative Services Inc
BO00013Advanced Primary Care Net
345Advantage by Bridgeway Health Solutions
346Advantage by Buckeye Community Health Plan
347Advantage by Managed Health Services
348Advantage by Superior HealthPlan
BO00123Advantica
292ADVANTRA (TEXAS, NEW MEXICO, ARIZONA ONLY)
1Aetna
936AETNA BETTER HEALTH (IL)
937AETNA BETTER HEALTH (KY)
938AETNA BETTER HEALTH (LA)
939AETNA BETTER HEALTH (MI)
940AETNA BETTER HEALTH (MO)
941AETNA BETTER HEALTH (NE)
942AETNA BETTER HEALTH (NJ)
943AETNA BETTER HEALTH (PA)
944AETNA BETTER HEALTH (TX)
945AETNA BETTER HEALTH (TX) CHIP
946AETNA BETTER HEALTH (WV)
935AETNA BETTER HEALTH VIRGINIA
10Aetna Long Term Care
948Affinity Essentials
349Affinity Health Plan
469Affinity Health Plan Medicare
949AFLAC
11AFLAC - Dental
470AFLAC - Medicare Supplemental
12Aftra Health Fund
950AGIA INC
13Alabama Medicaid
459Alameda Alliance Health Plan
951Alaska Medicaid
BO00062Alicare Multiplan
635All Savers Life Insurance
471Allegiance Benefit Plan Management
636Allied Benefit Systems
BO00024ALTAMED HEALTH SERVICES
14Altius Health Plans
670Ambetter Superior Health Plan
15AMC - Alaska Electrical Health & Welfare Fund
16AMC - Health Future
17AMC - Poly America
18AMC - Touchstone
19AMC - Touchstone PSO
637Ameriben
918American Behavioral Benefit Managers
20American Community Mutual
316American Family Insurance Group - Medicare Supplemental and PPO Policies
21American General Life and Accident
467American Health Medicare
412American National Insurance Company
413American National Life Insurance Company of Texas
22American Postal Workers Union (APWU)
23American Republic Insurance Company (ARIC)
MD002American Republic Insurance Company (ARIC)
350American Retirement Life Insurance Company Medicare Supplement
24AmeriChoice of New Jersey (Commercial)
25AMERIGROUP
929AmeriHealth
460AmeriHealth Administrators
351AmeriHealth Mercy Health Plan
BO00061Amerisure
26Ameritas Life
BO00033Angeles IPA
352Antares
BO00028APPLECARE MEDICAL GROUP
461Arbor Health Plan (Only Nebraska Area)
27Arizona Medicaid (AHCCCS)
205Arizona Physician's IPA
28Arkansas Medicaid
BO00026ASSOCIATED HISPANIC PHYS.
120ASSURANT HEALTH-JOHN ALDEN LIFE
188ASSURANT HEALTH-TIME INSURANCE
191ASSURANT HEALTH-UNION SECURITY
411Asuris Northwest Health
BO017ATRIO HEALTH PLANS
318Aultcare
BO001800Avera Health BO
896Avera Health Plan
206AvMed Health Plans
BO001830Bankers Fidelity
BO00063Bankers Life And Casualty
926Bankers Life And Casualty - EDI
472Banner Health Plans
931BCBS ANTHEM VIVITY
462BCBS Of Alabama (Institutional)
29BCBS of Arizona
30BCBS of Arkansas
330BCBS of Central New York
31BCBS of Connecticut
32BCBS of Georgia
463BCBS Of Hawaii
33BCBS of Illinois
34BCBS of Indiana
36BCBS of Kentucky
37BCBS of Louisiana
38BCBS of Maine
39BCBS of Michigan (Thru BLUE EXCHANGE)
40BCBS of Minnesota
41BCBS of Mississippi
42BCBS of Missouri
475BCBS of Montana
43BCBS of Nevada
44BCBS of New Hampshire
45BCBS of New Jersey (Horizon)
46BCBS of New Mexico
47BCBS of New York (Empire)
465BCBS of New York (Excellus)
311BCBS of North Dakota
48BCBS of Ohio
454BCBS of Oklahoma
49BCBS of Oregon (Regence)
50BCBS of Pennsylvania (Highmark)
476BCBS of Pennsylvania (Highmark) [Institutional]
51BCBS of Rhode Island
308BCBS of the Rochester Area (NY)
309BCBS of Utica-Watertown (NY)
477BCBS of Vermont
52BCBS of Virginia
331BCBS of West Virginia
325BCBS of Western New York
53BCBS of Wisconsin
312BCBS of Wyoming
BO008Beechstreet
478Benefit Management Inc
419Best Choice Health Plan
54Best Life and Health
55Better Health Plans (Unison Health Plan)
207Blue Cross Blue Shield Alabama (Commercial)
209Blue Cross Blue Shield Alaska (Premera)
210Blue Cross Blue Shield Colorado
282Blue Cross Blue Shield Delaware (Carefirst)
288Blue Cross Blue Shield District of Columbia (Carefirst)
211Blue Cross Blue Shield Florida
212Blue Cross Blue Shield Iowa (Wellmark)
213Blue Cross Blue Shield Kansas
306Blue Cross Blue Shield Kansas City
289Blue Cross Blue Shield Maryland (Carefirst)
214Blue Cross Blue Shield Massachusetts
215Blue Cross Blue Shield Nebraska
216Blue Cross Blue Shield North Carolina
217Blue Cross Blue Shield South Carolina
218Blue Cross Blue Shield South Dakota (Wellmark)
219Blue Cross Blue Shield Tennessee
220Blue Cross Blue Shield Texas
2Blue Cross of California
56Blue Cross of Idaho
479Blue Cross of Idaho
57Blue Cross of Northeastern Pennsylvania
221Blue Cross Washington (Premera)
S001Blue Exchange
3Blue Shield of California
480Blue Shield of North Eastern New York
58Blue Shield of Washington (Regence)
284BlueChoice HealthPlan South Carolina Medicaid
290Bluegrass Family Health
399BMC HealthNet Plan
420Boon-Chapman Benefit Admin
222Bravo Health, Inc.
952BRIDGESPAN
353Bridgeway Arizona
BO00027BRIGHT HEALTH PHYSICIANS/
354Buckeye Community Health
59California Medicaid (Medi-Cal)
60Capital Blue Cross (Pennsylvania)
328Capital District Physicians Health Plan (CDPHP)
BO00023CAPMN
482CAPROCK
891Care Improvement Plus
BO00098Care Improvement plus (BO)
638Care1st Health Plan Arizona
639Care1st of California
671CareMore Health Plan
223CarePlus Health Plan
224CareSource Health
61Cariten Healthcare
BO00025CARMO
483Carolina Care Plan, Inc. (CCP)
355Carpenters' Health and Welfare Trust Fund of St. Louis
BO00036CBCA Administrators
414CeltiCare
356Cenpatico - Arizona
357Cenpatico - Florida
358Cenpatico - Georgia
359Cenpatico - Indiana
360Cenpatico - Kansas
415Cenpatico - Massachusetts
640Cenpatico - Missouri
361Cenpatico - Ohio
362Cenpatico - South Carolina
BO00134Central Health Plan
225Central Reserve Insurance Company
363Central Reserve Life Insurance Company Medicare Supplement
315Central States Fund
63CHAMPVA/Spina Bifida/Children of Women Vietnam Vets
313CHC - Coventry Health Care Federal
9110CHC - Illinois
314CHC - Vista (MCD, FHK, LTC)
366CHC FLORIDA/VISTA/SUMMIT
64CHC of Delaware
65CHC of Georgia
66CHC of Iowa
67CHC of Kansas
68CHC of Louisiana
69CHC of Nebraska
907CHC OmniCare (Michigan)
228CHCCARES-SOUTH CAROLINA
653Christian Brothers Service
4Cigna
BO00037CNIC
BO018Colonial Penn Insurance
910Colonial Penn Life
894Colonial Penn Life
70Colorado Access
71Colorado Medicaid
421Columbia United Providers
72Community Care of Oklahoma
641Community Health Group
291Community Health Plan of Washington
422Community HealthFirst Medicare (CHF Medicare Advantage)
423ConnectiCare
73Connecticut Medicaid
226Continental General Insurance Company
364Continental General Insurance Company Medicare Supplement
501Continental Life-Aetna
74Cooperative Benefit Administrators (CBA)
76CoreSource (FMH)
77CoreSource (Little Rock)
78CoreSource (MD, PA, IL)
80CoreSource (OH)
424Corporate Benefit Service
MD001Country Life Insurance Company
82Coventry Advantra Freedom
229COVENTRY ADVANTRA SAVINGS
83Coventry Health and Life (Oklahoma)
293COVENTRY HEALTH AND LIFE-NEVADA
84Coventry Health Care Carelink (Advantra)
85Coventry Health Care Carelink Medicaid
86Coventry Health Care Carenet
933COVENTRY HEALTH CARE CAROLINAS WELLPATH
227COVENTRY HEALTH LIFE-TN ONLY
87Coventry Healthcare National Network
294COVENTRY MISSOURI
365Coventry Nebraska Medicaid
367COVENTRYCARES
904CoventryCares of Michigan
295COVENTRYONE
368CSA Fraternal Live Medicare Supplement
BO003Culinary Health Fund (back-office)
425DakotaCare
BO001801Dakotacare BO
BO077Delaware MAP
455Delaware Medicaid
920Dell Childrens Health Plan
PL003Delware Medical Assistance Program
426Denver Health Medical Plan
427Deseret Mutual (DMBA)
701Desert Mutual
BO010Dialysis Verification
88Diamond Plan (Maryland Medicaid)
89Director's Guild
231District of Columbia Medicaid
BO00137Easy Choice Health Plan
643EBMS
642Elderplan Inc
BO019Emblem Health Plan
BO00053EMBLEM HEALTH(BO)
101EMBLEM HEALTH-EDI
954EMPLOYEE BENEFIT MANAGEMENT SYSTEM (EBMS)
403Essence Healthcare
BO00124Eye Quest
BO9001Eyefinity
92Fallon Community Health Plan
428FamilyCare
644FCE Benefit Administrators
BO00020FCS01
93Federated Insurance Company
BO00125FHHS
329Fidelis Care New York
94First Ameritas of New York
BO000995First Choice Health
917First Community Health Plans
932First Health
BO006First Health (various plans)
9001First Health Life
BO00059First Priority Hlth
96First Reliance Standard Life
BO00039First United American Life
PL002Fiserv Health
645Florida Health Care Plans
429Florida Hospital Healthcare System
98Florida Medicaid
BO00126FMH
319Freedom Blue
404Fresenius Medical Care
919Gateway Health Plan
458Geisinger Health Plan
405Generations Healthcare
100Georgia Medicaid
BO00040GHI/Emblem(BO)
430Gilsbar
646Gold Coast Health Plan
647Golden Rule Insurance
101Government Employees Hospital Association (GEHA)
369Great American Life Assurance Company Medicare Supplement
370Great American Life Insurance Company Medicare Supplement
264GROUP & PENSION ADMINISTRATORS
486Group Health Co-Operative
BO000992Group Health Plan
103Group Health Plan (GHP)
371Group Practice Affiliates
BO00041Group Resources
BO00042Guardian
102GWH-CIGNA
909Harken Health
372Harmony Health Plan (WellCare of Florida)
104Harvard Pilgrim Health Care
232Hawaii Medicaid
484Hawaii Medical Service Assoc (HMSA)
BO00093Health Alliance
105Health Alliance Medical Plan (HAP)
648Health Alliance Medical Plan (IL)
BO00065Health America Advantra
BO00058Health America Of Pennsylvania
901Health America Of Pennsylvania
233Health Choice Arizona
649Health Choice Oklahoma
924HEALTH FIRST HEALTH PLAN
925HEALTH FIRST INSURANCE
431Health Net Medi-Cal
5Health Net National
6Health Net of Northeast
601Health New England Eligibility Standard
317Health Partners (Minnesota)
106Health Partners of Philadelphia
432Health Plan of San Mateo
BO00084Health Plans Inc.
107HealthAmerica And HealthAssurance
108HealthCare Inc. (Promina)
955HEALTHCARE MANAGEMENT ADMIN
BO00043Healthcare Partners
BO00054HEALTHCARE PARTNERS/HERITAGE
332Healthcare Solutions Group
109HealthCare USA (HCUSA)
373HEALTHe Exchange
374HealthEase (WellCare of Florida)
375HealthEase Kids (WellCare of Florida)
110Healthfirst New York
234Healthfirst of New Jersey
137HealthMarkets: Chesapeake National Life Insurance
136HealthMarkets: Mega Life and Health
138HealthMarkets: Mid West National Life Insurance
140HealthMarkets: Transamerica Life Insurance
326Healthnow
651HealthPlan of Nevada
957HEALTHPLANS INC
BO00044HealthPlus
111HealthPlus of Michigan
652HealthScope
280HealthSmart Benefit Solutions
333HealthSpring
342HealthSpring Life & Health Insurance Company
338HealthSpring of Alabama
341HealthSpring of Florida
340HealthSpring of Illinois
339HealthSpring of Tennessee
235HIPNY
433Hometown Health
BO00060HOP
297Horizon New Jersey Health
112Humana
434Humana of Florida
113Idaho Medicaid
632IEHP Direct
BO00092IEHP Direct Health Plan
114Illinois Medicaid
435Independence Administrators
115Independence Blue Cross (Pennsylvania)
436Independent Health
116Indiana Medicaid
916Indiana University Health Plan
236Inland Empire Health
BO013Innovante
376Integrated Mental Health Services
BO00045International Services
117InterValley Health Plan
118Iowa Medicaid
237Jackson Memorial Hospital Health Plan
437John Hopkins Health Plan
265JP FARLEY CORPORATION
121Kaiser Foundation Health Plan of Colorado
122Kaiser Foundation Health Plan of Hawaii
123Kaiser Foundation Health Plan of Ohio
124Kaiser Foundation Health Plan of the Mid-Atlantic
125Kaiser Foundation Health Plan of the Northwest
126Kaiser Permanente of Georgia
127Kaiser Permanente of Northern California
488Kaiser Permanente of Southern California
128Kansas Medicaid
129Kentucky Medicaid
654Key Benefit Administrators (KBA)
377Keystone Mercy Health Plan
438Kitsap Physician Services
BO00031LAMC IPA
655Lifewise Health Plan of Oregon
634LOCAL 1199
BO00046Local 272 welfare Fund
474Louisiana Health Exchange
130Louisiana Medicaid
238Lovelace Health Plan
378Loyal American Life Insurance Company Medicare Supplement
BO00056MAGNACARE
879Magnacare
95MAIL HANDLERS BENEFIT PLAN
656Maine Community Health Options
239Maine Medicaid
379Managed Health Services Indiana
380Managed Health Services Wisconsin
BO001820Manhattan Life
298Maricopa Care Advantage (Arizona)
299Maricopa Health Plan (Arizona)
132Maryland Medicaid
133Massachusetts Medicaid
BO00082MASSHEALTH
381MDWise Hoosier Alliance
923MDWISE Medicaid Health Plans
657MedBen
439MedCost Benefit Services
134Medica
135Medical Mutual of Ohio
7Medicare Part A and B
BO00047Medsolutions
658MedStar Health Plan
139Mega Life (Oklahoma City)
243Mercy Care Plan (Arizona)
334Mercy Health Care Plan
902Meridian Health Plan of Illinois
893Meritain Health
BO00048Meritian
244MetLife Dental Family
BO00049Metroplus
659MetroPlus Health Plan
141Metropolitan Health Plan (MHP)
245Michigan Medicaid
440Michigan Medicaid Pending Eligibility
246Michigan MIChild
BO00057Michigan Mutual
240Mid Atlantic Medical Services, LLC (MAMSI)
142Minnesota Medicaid
267MISSISSIPPI ADMIN SERVICES, INC
144Mississippi Medicaid
145Mississippi State Employees and Teachers Health Plan
146Missouri Medicaid
147MMSI (Mayo Health)
BO000991MODA Health Plan
148Molina Healthcare of California
300MOLINA HEALTHCARE OF FLORIDA
485Molina Healthcare of Illinois
150Molina Healthcare of Michigan
382MOLINA HEALTHCARE OF MISSOURI
247Molina Healthcare of New Mexico
151Molina Healthcare of Ohio
152Molina Healthcare of Texas
153Molina Healthcare of Utah
154Molina Healthcare of Washington
248Montana Medicaid
BO00064Monumental Life Insurance Co
BO009Motion Picture Industries
320Mountain State
BO00016MPM10
155Mutual of Omaha
156MVP Health Care (New York)
157National Association of Letter Carriers (NALC)
158Nationwide Health Plan
BO00073Nationwide Mutual Insurance
500NEHEN - Neighborhood Health Plans
249Neighborhood Health Partnership
502Neighborhood Health Plan RI
BO00083NETWORK HEALTH -BO
9012Network Health Insurance Corp
466Network Health Plan of WI
159Nevada Medicaid
BO00074New Era Insurance Company
902New Era Insurance Company
160New Hampshire Medicaid
161New Jersey Medicaid
162New Mexico Medicaid
163New York Medicaid
BO00030NMM01
164North Carolina Medicaid
250North Dakota Medicaid
BONONEDInot supported yet
441Nova Healthcare Administrators
335NovaSys Health
383Ohana Health Plan (WellCare of Hawaii)
165Ohio Medicaid
166Oklahoma Medicaid
167OmniCare (Michigan)
956OPERATING ENGINEERS LOCAL 428
BO015operating engineers welfare fund
BO000190Opticare
310Optima/Sentara
168Oregon Medicaid
169Oxford Health Plans
BO00015PA513
442Pacific Source Health Plan
304PacifiCare (PPO)
254PacifiCare of Arizona (HMO)
8PacifiCare Of California
255PacifiCare of Colorado (HMO)
443PacifiCare of Nevada (HMO)
BO001Pacificare of Nevada [BackOffice]
170PacifiCare Of Oklahoma
251PACIFICARE OF OREGON
252PACIFICARE OF TEXAS
253PACIFICARE OF WASHINGTON
660Pan-American Life Insurance
BO00014PAPER
921Paramount Health Care
444Partners National Health Plans of NC
256Partnership Health Plan of California
384Passport Advantage
257Passport Health Plan
385Peach State Health Plan
171Pennsylvania Medicaid
922PerformCare
322Personal Insurance Administrators
230PERSONALCARE
BO007PHCS
307PHCS Savility Payers
258Phoenix Health Plan
BO00019PHYSICIANS CARE
BO00095Physicians health choice
172Physicians Mutual Insurance Company
260Pittman and Associates
173Preferred Health Systems
BO00032Preferred IPA
BO00022PREFERRED IPA OF CA
261PreferredOne
BO00011Premier Eye Care
661Premier Health
662Prestige Health Choice
321PrimeWest Health
174Principal Financial Group (Nippon Life)
175Principal Financial Group (Principal Life)
324Priority Health
268PROFESSIONAL BENEFITS ADMIN (IL)
262Providence Health Plan
386Provident American Life & Health Insurance Company Medicare Supplement
445Public Employees Health Plan (PEHP)
263Puerto Rico Medicaid (ODSI)
663QualCare
402Qualchoice
387QuikTrip Corporation
BO00021REGAL
176Reliance Standard Life
270Rocky Mountain Health Plan
271San Francisco Health Plan
272San Joaquin Health Plan
BO001789Sanford Health BO
400Sanford Health Plan
446Santa Clara Valley Health and Hospital
177SCAN HMO
305Scott White Health Plan
664Secure Health Plans of GA
BO00068Security Blue
388Select Health of South Carolina
447Select Health Utah
BO002Self Pay
BO00097Seton Health
777Sharp Health Plan
473Sierra Health Service
91Significa Benefit Services
665Simply Healthcare Plans
666Soundpath Health
BO00029SOUTH ATLANTIC MED. GRP.
273South Carolina Medicaid
179South Dakota Medicaid
180Southern Health Services (SHS)
389Special Agents Mutual Benefit Association
390SPJST Medicare Supplement
181Standard Insurance
182Standard Insurance of New York
MD003Standard Life and Accident Insurance
416Standard Life and Accident Insurance Company
183Star HRG
BO00070State Farm Health Ins
897State Farm Ins
1908State Mutual (Lincoln Novation)
391StayWell (WellCare of Florida)
392StayWell Kids (WellCare of Florida)
BO00072Sterling Life Insurance (BO)
BO00001Stirling Benefits Inc
9201Stonebridge Life Insurance Company
BO011STTEC-Secure Horizons
184StudentResources
448SummaCare Health Plan
327Sunshine State Health Plan
393Superior HealthPlan Texas
BO00096Superior Vision
BO004Teachers Health Trust (back-office)
185Tennessee Medicaid (TennCare)
406TexanPlus - North Texas Area
407TexanPlus - Southeast Texas Area
275Texas CHIP
186Texas Medicaid
BO00111Texas Medicaid BO
667The Loomis Company
187Three Rivers Health Plans (Unison Health Plan)
408Today's Health
409Todays Options
953TRANSAMERICA LIFE INSURANCE HEALTHMARKETS
BO00067Travelers Insurance Company
410Tribute / SelectCare of Oklahoma
9Tricare
9502TRICARE for Life
9401Tricare West
BO00112Tricare-Pending
189Trustmark Insurance
190Tufts Health Plan
BO016UAW retirees medical benefits
449Ucare of Minnesota
BO00050UMR
417UMR Wausau
269UNDERWRITERS SAFETY & CLAIMS
303Unicare
394Union Pacific Railroad Employes Health Systems
BO00069Unison Administrative Services
PL004UNISON MEDICAID
192United 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
395United Teacher Associates Insurance Company Medicare Supplement
UHG001UnitedHealth Group - Community Plan
277UnitedHealthcare Plan of the River Valley
450Unity Health Plans
451Univera
193Universal Care of CA
668University Care Advantage AZ
278University Family Care
296UNIVERSITY OF MISSOURI
301University Physicians Care Advantage (Arizona)
302University Physicians Healthcare Group (Arizona)
452UPMC Health Plan (Tristate)
BO00051US Family Health Plan
194USAA-Medicare Supplemental
195VA Fee Basis Program
BO00066Valley Preferred
396Vantage Health
196Vermont Medicaid
197Virginia Medicaid
337Vista (MCD, FHK, LTC)
336VIVA Health
397VNS CHOICE
279Vytra
198Washington Medicaid
453Washington Medicaid (ProviderOne)
401WEA Trust
398WEB-TPA, Inc.
BO00052Wellcare
418WellCare Health Plans
BO012WellMed
199Wellpath Select (Carolinas)
200West Virginia Medicaid
669Western & Southern Financial Group
281Western Health Advantage
201Wisconsin Medicaid
286Wisconsin Medicaid Chronic Disease Program
287Wisconsin Medicaid Well Woman Program
202World Insurance (ARIC)
203Writers Guild
204Wyoming Medicaid
BO00055ZURICH
BO00071Zurich American Ins. Co.

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

 

 

 

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