Real-Time Insurance Eligibility Verification


Real-Time Insurance Eligibility Verification Video

Watch a quick video primer on how you can use PokitDok to integrate real-time, member-specific benefits data directly into your application or service.


Video Transcript

Welcome to PokitDok’s video series, recording from the Zucker family Graduate Education Center on Clemson University’s campus in Charleston, South Carolina.

 

My name is Denise Gosnell and I’m PokitDok’s tech evangelist. In this video, I’ll be walking through a high level overview of our eligibility API and the healthcare use cases that can be solved with this API.

 

As I see it, we’re just taking a page from the financial industry’s history book. So let me explain. Hospitals and doctors offices, or really any healthcare provider or consumer, would like to know whether or not a patient is covered for care. Within the industry, this request is known as a real-time insurance benefit verification. And before PokitDok, there was not anything real time about it. But at its core, an eligibility transaction is just asking the question, “according to the patient’s insurance plan, is this patient eligible to receive care from this doctor?”

 

And until recently, accessing this information has been primarily a manual process. The provider staff would have to call the insurance company, send a fax, or log into multiple web portals in order to check for a patient’s benefits. In the background of these manual processes there exists an entire industry of third party trading partners, which pass data from one entity to another. Why is the healthcare industry still relying on phone calls, fax machines, or complicated web portals to get answers to basic questions?

 

Well, when PokitDok started digging into creating technology to solve this problem, we saw many parallels with the FinTech industry. Between the 1990s and now, APIs transformed the digital infrastructure of the FinTech industry. Before, you were required to step into a physical bank to access your money. Now, you have the ability to access financial assets real time through ATMs or apps, all powered in the background by a digital infrastructure of APIs.

 

The PokitDok eligibility products take a page from this history in the financial industry. Our eligibility products tap into the entire network of payers and trading partners to establish real-time access to any patient’s benefit coverage information, like a patient’s coverage status, their deductible limits, spending amounts, and co payment details, just to name a few. In the background, we handle the complex infrastructure of trading partner connections throughout the healthcare industry so that you can get access to what you really care about — the data.

 

Within our eligibility products, you can give a provider accurate insurance information at the point of care, which can lead to fewer rejected claims, faster payments, and ultimately more revenue. PokitDok has three eligibility products ready to get you connected to real-time insurance benefit verification: the eligibility API, the eligibility drop-in UI, and the eligibility web app.

 

If you haven’t already, you can get started by signing up for an API key at platform.pokitdok.com, and start exploring the eligibility API. It’s free to test and we have open-sourced some API clients on PokitDok’s GitHub profile. Or, if you are more interested in accessing our customizable UI or web app, drop us a note on our forum at pokitdok.com/contact.

 

In the following video in this webinar series, I will dive in and do a technical demo of our eligibility products. But between now and then you can follow us on our tech blog at fullmetalhealth.com to keep up-to-date with what PokitDok is building as we continue to break down the silos within the healthcare industry.