API Descriptions


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Providers API

Search for providers from one of the largest provider directories. Our directory provides biographical information, education, credentialing, and other quality and business information. Use this API to let customers select providers based on a variety of factors.

Cash Prices API

Based on our proprietary database, this API calculates the average cash price providers within a certain geographic area charge for a specific service. This is a good reference point for customers to use when selecting a provider for services or for selecting a geographic area to obtain those services.

Insurance Prices API

Based on our proprietary database, this API calculates the average price for a service that providers are submitting to an insurance carrier within a specified area. This information can be used by customers to get an idea of how much they might save between a cash price versus insurance price. It can also be used as a guide to select a geographic location for obtaining health care services.

X12 Claims & Eligibility

Eligibility API

Checks to see if your customer is a current and active member of specific health plan. It's currently available for all major carriers, covering more than 80% of covered lives across the U.S. It provides information on what the customer's deductible is and how much has been satisfied, helping to calculate a customer's out-of-pocket expense for a healthcare transaction.

Claims API

Submits a Professional CMS 1500 claim to the specified insurance carrier usingthe Claims API. Please note, the Claims API only submits claims to an insurance carrier, it does not scrub claims. This API can be used to make sure a patient's up front cash payment counts against their deductible.

Claims Status API

Checks with the insurance carrier what the status of a claim is. It has information on the outstanding claims for a patient and what claims have been received, are being processed or have been finalized. This is especially important for office billing managers who need a complete picture of where high dollar claims stand on a real-time basis.

Plans API

The Plans API can check a customer's insurance carrier and see what their plan design is. This information is used in determining the benefits, copayments, or coinsurance a patient has.

Enrollment API

The Enrollment API allows the enrollment of new members into an insurance plan, updating of information or changes the status of a member's enrollment. An insurance broker or plan administrator would use this API to electronically enroll a customer or make benefit changes in the case of a life event.

Referrals API

The referrals API is used when a patient needs a referral in order to be authorized by the insurance carrier to obtain health care services from another provider.

Authorizations API

The Authorizations API determines if pre-authorization has been given for a specific service by their insurance carrier.

Interoperability

Scheduling API

The Scheduling API works across multiple EMR/EHR systems and gives the ability to schedule a healthcare provider appointment directly into the provider's appointment schedule. Use this tool to enable online booking of appointments.

Identity Management API

The PokitDok Identity Management System (IdM) is an API which matches and stores each of an associated patient's identities found in multiple target EMPIs (Enterprise Master Patient Index) and/or MPIs (Master Patient Index). It ties together multiple patient files within an EMR/EHR system and across EMR/EHR systems.

Other APIs

Activities API

Keep track of your API usage through our Activities API. Data on your APIs help you drive and grow your business intelligently.

Insurance Carrier Trading Partners API

This is where you will find an always current list of the insurance carriers and health plans that are partnered with us to exchange information. It also provides details on what types of information we can exchange with each of these partners