SANTA CLARA, Calif.--(BUSINESS WIRE)--PokitDok Inc. announced today at Health 2.0 that it eliminated charges for essential transactions with insurance carriers, driving down the overhead costs often absorbed by physicians, benefit enrollment administrators and digital health companies. Effective today, transactional fees traditionally incurred for insurance enrollment, eligibility checks, claims processing, authorizations and medical referrals will be removed when using PokitDok’s X12-compliant Application Programming Interfaces (APIs). With its network of health insurance carriers that support 83 percent of covered lives, PokitDok introduces a more fluid, modern and inexpensive approach to streamline healthcare transactions and connect health providers and emerging access models to insurance carriers nationwide.
More than 300 million US residents are required, by law, to maintain insurance, and they ultimately carry the burden of unnecessary administrative costs in the $3 trillion healthcare system. Clearinghouses were created to serve as intermediaries between insurers and providers for basic Electronic Data Interchange (EDI) associated with medical billing and to assist in driving digital adoption across health systems and practices. They became commonplace largely as a result of the 1996 Health Insurance Portability & Accountability Act (HIPAA) which was enacted to standardize healthcare transactions. To address compatibility across all parties involved in medical care, “X12” became the interchange protocol. Built on aging, legacy infrastructure, X12 standards have resulted in huge hidden costs often borne by the health provider and their patients. The result is a system that has obscured the true cost of care and is too reliant on antiquated technology.
Introduced in 2014, PokitDok’s X12 APIs follow the standard ASC X12 format, allowing businesses of any size access to essential health transactions, such as an 837 Healthcare Claim file. PokitDok manages health insurance carrier connectivity, file validation, encryption and transmission that is secure and HIPAA compliant. Healthcare transactions that formerly required implementing the complex, archaic ASC X12 transaction sets can now be performed simply, at no charge per transaction.
“Our mission is to drive the operational cost of healthcare down and to put the dollars saved back into the provider and patient’s pockets. We are removing waste in the business of health through open APIs based on X12 and other trusted healthcare standards,” said Lisa Maki, co-founder and CEO, PokitDok. “Until now, healthcare costs have been inflated by business processes and models today’s technologies make obsolete, such as clearinghouse charges for processing common transactions like checking patient coverage and submitting claims. Today’s announcement is the latest step in PokitDok’s mission to remove waste and increase value at every level, including the individual transactions that underlie the business of health.”
Lisa Maki will elaborate on this announcement during a presentation today at 5:30 PT in the Mission City Ballroom at the Santa Clara Convention Center. For more information drop by PokitDok’s booth #312 or go to platform.pokitdok.com.
PokitDok provides cloud-based web services to integrate healthcare transactions into any app, website or product. This includes eligibility checks, claims submissions, scheduling, payment processing, interoperability and patient identity management. PokitDok makes current cash and insurance prices available for health services from over 40,000 providers in 44 US markets through its API and marketplace. Large group providers, healthcare systems integrators, telehealth businesses use PokitDok to scale quickly, create better consumer experiences, streamline operations and cut costs. PokitDok is based in San Mateo, CA and Charleston, SC and is backed by Lemhi Ventures, Rogers Venture Partners, New Atlantic Ventures (NAV.VC) and Subtraction Capital.