PokitDok Awarded CAQH CORE Endorser Seal, Demonstrates Commitment to Simplifying Insurance Verification

By PokitDok Team,


We are proud and excited to announce that PokitDok has been awarded a CAQH® Committee on Operating Rules for Information Exchange (CORE®) PHASE II Endorser Seal, showing our commitment to advancing the business of health via our commitment to streamlined electronic healthcare administrative data exchange. PokitDok applied for CORE Endorser status because it supports CORE’s mission, collaborative industry approach and administrative simplification objectives. CAQH launched CORE to give providers consistent access to patient coverage information before or at the time of service using the electronic system of their choice for any patient or health plan, effectively reducing administrative burden and costs.

“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.

Read the full press release.

The opinions expressed in this blog are of the authors and not of PokitDok's. The posts on this blog are for information only, and are not intended to substitute for a doctor-patient or other healthcare professional-patient relationship nor do they constitute medical or healthcare advice.

  Tags: Dev, Enterprise

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