Our Eligibility Endpoints

The core business of pVerify is Eligibility.

Healthcare Eligibility APIs

Championing the highest level of benefits parsing with consumable API endpoints

About Healthcare Eligibility APIs


For the past 15 years pVerify has successfully helped a wide variety of customers with their Eligibility needs. pVerify’s Real-Time Exchange System facilitates the secure exchange of health care Eligibility and related transactions, supporting one-to-one transactions.

 For healthcare companies, pVerify shines alone in the industry for unprecedented support, excellent development tools, easy to use APIs (REST and drop-in user interface), and quick development to production timelines, along with an affordable introductory price point.

Healthcare Eligibility APIs

pVerify’s API endpoints are calls from a client’s own system, sent to pVerify then through to a payer via one of our redundant connections to verify patient eligibility. We return the payer data, normalize it, parse it using our business logic and artificial intelligence, then return it to your system.  We are the only clearinghouse that can provide non electronically linked payers and vision payers such as VSP, using the same workflow and interface used for the common payers such as Medicare.

Features of pVerify’s Advanced Healthcare Eligibility APIs

  • A blend of machine and human-enabled AI and business logic to give consistent and parsable data such as specialist office copay.
  • Fully parsed details so you can easily capture what you want – Copays, active status, network status, etc.
  • The Largest Medical Insurance Verification Payer List in the industry.
  • Discover a patient’s insurance with Name and DOB details if payer supports it.
  • Capture copays and co-insurance for multiple services in one verification.  For example dx lab, in office visits, and physical therapy, all in one transaction.
  • Highest level of benefits parsing with consumable API endpoints, with refined and maximize benefit reporting.
  • With All-payer Eligibility, electronic (EDI) and non electronic (Non-EDI) including Medical, Dental, and Vision Payers

The Best Healthcare APIs 

pVerify’s robust APIs are available for the following services

Recursive Medicare Advantage

Verify a Medicare Advantage Payer automatically from a Medicare transaction, using our proprietary methods, and obtain the MA Plan Subscriber ID and coverage details

MBI Lookup

Find a Medicare patient's new MBI ID with their name and SSN/HICN

Experts in APIs

With hands-on and responsive Healthcare Eligibility API Support, pVerify assists with designing your Healthcare API workflow, acts as a hand-on guide throughout development, and remains a go-to expert post development.

Realtime Healthcare API Eligibility API