pVerify API

 

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

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.

Dependent Methods

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  • VerifyEligibility – this is the main start point for eligibility transactions, input parameters are member ID / demographics and output is unique ID Example

VerifyEligibility Response Status codes:

StatusCode Meaning

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

*: 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.

  • GetCoPaybyServiceName – This gets a parsed list of copay information by service name (as a required parameter)
  • GetDemographics – this returns parsed demographic from the eligibility report
  • GetEligibilityReport – this returns the full text of the eligibility report from the clearinghouse
  • GetEligibilitySummary – this returns summary information regarding eligibility status, copay, out of pocket, and deductable, PER SERVICE. The user must provide service name which can be found via GetServiceNames
  • GetEligibilitySummaryFULL – this returns summary information regarding eligibility status, copay, out of pocket, and deductable, FOR ALL SERVICES. It also returns the full text of the report as in GetEligibilityReport Example
  • GetPremiumBenefits – this returns patient name, eligibility status, and a summary of benefit information (OOP, deductable, copay, coinsurance)
  • GetServiceNames – this returns a list of service names for a particular eligibility request

Independent Methods

We also have a few methods that do not require VerifyEligibility to be run first.

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  • getPayerSearchCriteria – this returns a list of search criteria (ie name, DOB, memberID) a particular payer is using