SAN MATEO, Calif.--(BUSINESS WIRE)--In its mission to power the business of healthcare, PokitDok announced today that it has received a Phase II CAQH® Committee on Operating Rules for Information Exchange (CORE®) Certification Seal, demonstrating its commitment to streamlining electronic healthcare administrative data exchange. PokitDok achieved CORE Certification because it successfully implemented the Phase II CAQH CORE Operating Rules, which ensure access to a richer set of consistent and accurate electronic administrative data, such as eligibility, benefits, claim status, and patient financial information.
“We are re-imagining healthcare delivery and the technology infrastructure to support it,” said Ted Tanner, Jr., co-founder and CTO, PokitDok. “Receiving the Phase II CORE Certification is a public recognition of our remarkable development team and our deep domain expertise in healthcare. This is an accolade that reinforces the level of trust our business partners and customers have in us.”
CAQH CORE is a multi-stakeholder collaboration committed to the development and adoption of national operating rules that support health plan-provider interoperability and improve provider access to administrative information. CAQH CORE has been designated by the Secretary of the Department of Health and Human Services (HHS) as the author for federally mandated operating rules that are part of the Patient Protection and Affordable Care Act (ACA).
To date, the voluntary industry-wide initiative has brought together more than 140 healthcare industry stakeholders – health plans, providers, vendors, CMS and other government agencies, associations, regional entities, standard-setting organizations, and banking industry experts – to develop a set of business rules that make electronic administrative data communications seamless, streamlined, and predictable, regardless of the technology. In many cases, the CAQH CORE Operating Rules eliminate the need for practice staff phone calls.
“The CAQH CORE Operating Rules represent a cutting-edge approach to improving electronic communication between providers and payer organizations," said Robin J. Thomashauer, CAQH executive director. "By becoming CORE-certified, PokitDok is demonstrating its support for an initiative that is reducing unnecessary healthcare administrative burden, and helping U.S. healthcare become more efficient and responsive to patient concerns.”
PokitDok developed a secure method for the transmission and reception of healthcare information that helps the industry conform to new governing rules. It also improves care coordination, prevents delays, and reduces administrative costs. With formal agreements with more than 392 health insurers, PokitDok can be used for health plan enrollment management, to check eligibility for health services based on a patient’s insurance plan, to pre-authorize specialist referrals, and submit claims and ascertain their status. PokitDok’s X12 APIs follow the standard ASC X12 format, allowing businesses of any size access to essential health transactions. PokitDok manages health insurance carrier connectivity, file validation, encryption, and transmission. Healthcare transactions that formerly required implementing the complex, archaic ASC X12 transaction sets can now be performed with the ease of modern data formats, like JSON while conforming to CORE standards.
PokitDok has completed a rigorous review process to earn both Phase I and Phase II CORE Certification. CAQH CORE Phase I entails compliance of real-time connectivity and ASC X12 005010X279A1 Eligibility and Benefit Request and Response (270/271) transactions. Phase II entails further compliance of real-time ASC X12 005010X279A1 Eligibility and Benefit Request and Response (270/271) and ASC X12 005010X212 Health Care Claim Status Request and Response (276/277) implementation guides.
PokitDok streamlines the business of healthcare, by providing access to universally needed data and services. This includes Application Programming Interfaces (API) for eligibility checks, claims submissions, scheduling appointments, payment processing, or patient identity management for example. Large hospital systems, digital health startups, systems integrators, and telehealth companies use PokitDok’s development platform and APIs to improve business processes, cut costs, discover business patterns with big data, and create better consumer experiences. PokitDok is based in San Mateo, CA and Charleston, SC and is backed by Lemhi Ventures, Rogers Venture Partners, McKesson Ventures, New Atlantic Ventures (NAV.VC) and Subtraction Capital.
About CAQH CORE
CAQH CORE was formed in 2005 to drive the creation and adoption of healthcare operating rules that support standards, accelerate interoperability, and align administrative activities among providers, payers and consumers. Today, more than 140 organizations participate in CAQH CORE, including healthcare providers, health plans representing 75% of insured Americans, vendors, government entities, and standard setting organizations. CAQH CORE Operating Rules were issued in four phases, and CORE Certification is currently available for Phases I, II and III Operating Rules. For more information, visit www.caqhcore.org.
CAQH CORE®, the CORE-certification/Endorser Seals and logo are registered trademarks of CAQH® Copyright 2010, Council For Affordable Quality Healthcare®. All rights reserved