Updates to PokitDok's Eligibility & Trading Partners APIs

We have an exciting update for PokitDok's Eligibility and Trading Partners APIs! Previously, our eligibility endpoint required all four patient identifying request parameters (first name, last name, member ID, and date of birth) with every request. Because not all trading partners require all four pieces of information and some will return errors with limited request information, we have updated our endpoint to require only the parameters needed by the trading partner being called.

In addition, the trading partners endpoint now returns these specific eligibility parameter preferences along with other previously available trading partner information, where primary search includes all four patient identifying request parameters.

Here’s an example of a trading partner endpoint response for Aetna:

What does this mean, you ask? This response helps avoid the pain of tracking down additional patient data that may be unnecessary to receive a successful eligibility response. For instance, if a member shows up at a physician’s office without a member id card, some trading partners allow for a look up with a first name, last name, and date of birth. Now, assuming the trading partner does not require a member id, you can successfully check patient eligibility.

Here’s an example of an eligibility request to determine general health benefit coverage using the no_id_search search option:

PokitDok will conduct initial validation on an eligibility request to determine if the minimum required request parameters for the trading partner being called are present. If those parameters are not included in the request, a PokitDok error message will be returned. It might look something like this:

"Based on the X12 specification and trading partner implementation guide, the supplied member data needs to match one of these search options: [[\"last_name\", \"id\", \"birth_date\"]]".

Additional details on this update can be found in our documentation.

 

About Faride Beaubien

Faride is a technical and administrative professional with over 10 years experience in healthcare, real estate, private equity and technology. She is known for being a challenge seeker, problem solver & getting stuff done.

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