Take a deeper dive into PokitDok's APIs to see how our software works to streamline healthcare transactions and power the business of health.
This free of charge utility API is used to track the life cycle of a transaction. Results returned will follow the states through which an Activity flows in the PokitDok platform. Activity tracking information is returned to the caller, which can be used to query the status of the activity later on. Information concerning the activity's progression through the system is available via the API Dashboard.
Based on our proprietary database, this API calculates the average cash price providers charge for a specific service, within a certain geographic area. 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.
Claims are typically accepted via a batch file transmission. Once you POST a Claims API request and it passes PokitDok validation, an activity is created in our system and it enters a "scheduled" state. We return the activity id which can then be used with the Activities API to track the status of the activity as it moves through the workflow at no charge. Our system will pick up "scheduled" activities and submit to the trading partner via their approved secure file transfer method. After an activity is transmitted to the trading partner, it will enter a "waiting" state for generally 24 hours. There may be additional delays if the trading partner is experiencing technical difficulties. A trading partner's first response lets you know if the request has been accepted (or rejected) by their claims validation system.
Once your claim submission is accepted by the trading partner, it will enter their adjudication system. A tracking id will be assigned after passing the validation stage, which can then be used in claims status requests to track the claim. A claim can be monitored via a Claims Status request once the claim has been accepted in the trading partner's adjudication system. If you submit a Claims Status API request immediately after submitting a claim, it may not be found in the payer's system. Claims may sit in a queue for generally a week before entering the adjudication system so a Claims Status API request will not return anything during this time period.
Once adjudication is complete, the trading partner may return an electronic acknowledgement or an electronic remittance advice (ERA), otherwise a paper remittance advice is sent with final adjudication information. ERA availability may vary by trading partner and requires registration.
Claims Status API requests are submitted to the trading partner in real-time. Once a request passes PokitDok validation, the request is sent to the trading partner. If request is valid, a response is returned in real-time (typically within a few seconds). An activity is created in our system at submission. We return the activity id which can then be used with the Activities API. Response times can vary by trading partner.
Many PokitDok users require more insight into the claims submission process than can be attained through the use of the claims status endpoint. We accommodate this need through our activities endpoint and callback url. These endpoints allow users to see where the claims that have been submitted through PokitDok are in the PokitDok system, as well as give a more detailed response from the trading partner than can be attained through a claims status request.
Eligibility API requests are submitted in real-time. Once a request passes PokitDok validation, the request is sent to the trading partner. If request is valid, a response is returned in real-time (typically within a few seconds). An activity is created in our system at submission. We return the activity id which can then be used with the Activities API. Response times can vary by trading partner.
The PokitDok Identity Management (IdM) API allows for querying an EMPI (Enterprise Master Patient Index) and/or MPI (Master Patient Index), typical components of EMR or EHR systems, in order to find record identifiers and details in target systems. These Identity Management endpoints will identify, match, prove, and store each of the associated record identities in multiple target EMPIs. Additionally, the Identity Management API supports historical data loads for configurable duplicate entity detection.
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 and insurance price. It can also be used as a guide to select a geographic location for obtaining healthcare services.
PokitDok's Pharmacy APIs allow the ability to dive into a member's prescription benefits with a pharmacy benefit plan number. PokitDok's 270/271 Eligibility API can be used to look up a member's plan number for Medicare Part C and D plans.
The Pharmacy Plans API returns a member's pharmacy plan information such as plan name, premium, deductible, initial coverage limit and copays for each tier (initial coverage phase).
The Pharmacy Formulary API returns specific coverage such as tier level and restrictions including prior authorization, step therapy, and quantity limit, as well as details about a medication's out of pocket cost and average total cost including insurance reimbursement.
The In-Network Pharmacy API returns in-network pharmacies for a plan, or returns the details of a particular pharmacy (such as if it is in-network, if it is a retail pharmacy, etc).
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.
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.
The Referrals API allows an application to request approval for a referral to another health care provider.
Primary Care Physicians can enable their patients to receive the consult and services of a specialist or specialist entity. This request will be sent to the reviewing entity (e.g. Utilization Management Organization) for approval.
This API gives access to the current list of insurance carriers, health plans and third party administrators that are partnered with us to exchange information. It also provides details on what types of connections are available and whether setup or NPI registration is required. For more information, please see our documentation or FAQs.