PokitDok today said that 152 insurers were added as “trading partner connections,” with the goal of automating back-end communications between payers and providers, thereby reducing costs on overhead and making the data exchange between them more valuable.
The Silicon Valley startup said the new information from insurers will allow health systems, health IT entrepreneurs, employer groups, insurers and the state and federal exchanges to:
— exchange data for health plan enrollment
— determine a patient’s eligibility for health services based on their insurance plan
— pre-authorize specialist referrals
— submit claims and ascertain their status
Typically, after consumers show their insurance card for a medical visit, the provider’s back office will call the insurance company to verify and assess coverage and eligibility. Once medical services have been provided, a claim is then mailed to the insurance company seeking reimbursement and much of the process is tracked and stored on flat files. The PokitDok Platform seeks to take this manual process and automated it through software as a service, which can be integrated into the provider’s technology network through an API.
The addition of so many insurers should help PokitDok market itself to health systems, but because it’s an open platform, it’s often used by other digital health companies and brokers.
“PokitDok gives us the tools to help our customers minimize costs and prepare for HIPAA electronic compliance mandates that will be effective in 2016,” Allen Byerly, CTO of Grouphub.io, a startup that seeks to help brokers and consumers with enrollment, said in a statement. “Insurance brokers can start to eliminate paperwork, prevent manual errors and automate data exchange now…”
PokitDok’s API platform, which leverages established electronic data interchange agreements with insurers, now represents 75 percent of the covered American population, the company said. Part of the goal is to help overcome challenges related to HIPAA-compliant data sharing, specifically related to prior authorizations and
The industry standard for electronic transmission of health information, from enrollment to claims submission, is called HIPAA ASC X12 5010. That part of HIPAA, according to PokitDok, was intended to make the healthcare system more efficient by standardizing healthcare transactions like eligibility requests and health plan enrollment.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
The Affordable Care Act then established additional rules aimed at requiring standardization for health transactions, so PokitDok is rolling out a centralized method for the transmission and reception of health information that it says will improve care coordination, prevent delays, reduce administrative costs and helps the industry conform to new governing rules, including benefit enrollment and maintenance pre-authorization and referral standards.
“Beginning with Aetna, PokitDok brought the necessary industry relationships together, coupled with a technical architecture, to solve real integration and data integrity issues faced by nearly every healthcare institution,” said Lisa Maki, co-founder and CEO of PokitDok. “Companies don’t have to rip and replace their IT systems to conform to legislative mandates and support higher volumes of data exchange. Because of PokitDok’s trading partner relationships, data exchange can take place flawlessly, at an accelerated pace, driving costs down and helping companies adapt to the new consumer-driven healthcare system.”
The company also recently boosted its efforts in price transparency with the roll out of a national price index on dozens of the most common procedures.
