Time to Change from Change’s Healthcare Eligibility APIs

Healthcare Eligibility APIs

We are very sorry to hear that Pokitdok sunsetted their developer Healthcare Eligibility APIs.  pVerify has look had a cordial relationship with Pokitdok and wish them all the best.  We have taken lessons from Poktidok and are now the industry leader in healthcare eligibility APIs, for the simple reason that we are the only company in this space that primarily focuses on eligibility, and we have been developing resources in this space for 15 years.   We now have an unprecedented collection of tools to provide your company with all of its eligibility needs, where it’s Medicare MCA plan information, or a specialist copay value, pVerify has you covered!

We are the only company that uses business logic in our system to return parsed data for over 800 payers.  Instead of a massive lump of data you need to present to the end user, or try to parse yourself, we have done this, and this is the core of our business.   We have connections to all payers, and many payers who do not support EDI 270/271.

We are the only company that splits eligibility not by service code, which is unreliable, and confusing, but by Practice Type, which is clearly understood, and can be combined.  For example, Dermatology often wants in-office specialist copay, diagnostic lab copay, and in office surgical benefits.  Most companies can’t even provide one of these, let alone three in a single transaction.  pVerify can.  Further, in office surgical benefits are often very difficult to capture because they are not a typical service code section, forcing medical practices to make phone calls, have complex rules that must be distributed, or do web lookups.  To solve that, we have done several things.  First, we allow medical practices to actually create their own rule engine, such as this:  For Aetna, for this plan X, the in-office surgical copay/coinsurance is the same as the office visit copay.  Second, we have increased our non-EDI capability to actually go and collect this information from the payer.

Lastly we are the only company in this industry that is primarily a SERVICE industry and not a TECHNOLOGY company.  TECHNOLOGY companies create amazing apps powered by very smart people in San Francisco, and those people then wander off and do their own thing, and the app then stagnates.  There is no support, no upgrades, no help.  pVerify on the other hand is primarily a service.  We provide a solution to eligibility, not a means in which to get eligibility.  We help with onboarding for app developers, we make continual improvements to our system, we continuously monitor the system in case of payer outages (Tricare for Life, looking at you!), and you can reach us via email, phone, or ticket.  We’re real humans, just like you, and if you don’t succeed, well guess what, neither do we.


Robert Dejournet, COO & CTO at pVerify, Inc

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