Financial

Exchange information about money that's due and money that's paid.

Claims and Remittance

These interfaces are used to provide claims status, scrubbing and adjudication as well as automated payment posting. Our ANSI ASC X12N interfaces support HIPAA-standard transaction formats and versions and interoperate with a wide array of trading partners using these standards.

Outgoing interfaces refer to interfaces in which the EMR sends the message. Incoming interfaces refer to interfaces in which the EMR receives the message.

Outgoing Health Care Claims for Institutional, Professional, and Dental Services

This outgoing batch interface sends insurance claim information to payors and intermediary systems using industry standard ANSI ASC X12N 837 transactions (institutional, professional and dental). Current integrations include...
  • Availity
  • Change Healthcare
  • Cirius
  • ClaimLogic
  • ClaimLynx
  • Experian Health
  • GatewayEDI
  • Healthcare IP
  • nThrive
  • Optum
  • OS inc
  • Quadax
  • RelayHealth
  • SSI
  • WayStar

Outgoing Health Care Data Reporting Claims

This outgoing batch interface sends insurance claim information to government and intermediary systems using the industry standard ANSI ASC X12N 837 data reporting transaction.

Claim Reconciliation (CRD) read the specRead the technical specs

This incoming batch interface loads information about claim status in a configurable flat file or ANSI ASC X12N 277 or 277CA format. This interface can update the status of claims in the system and is able to load claim error information from payor and intermediary systems.

The flat file format is configurable, but the above common specification is pre-configured in the Foundation System for Epic customers and widely used with success. Current integrations include...
  • Availity
  • Cirius
  • ClaimLogic
  • Emdeon
  • Experian Health
  • GatewayEDI
  • Healthcare IP
  • nThrive
  • Optum
  • Quadax
  • RelayAssurance
  • SSI
  • WayStar

Rapid Retest (Accelerated Claim Reconciliation)

This bi-directional interface builds upon the use of standard Claim Reconciliation sends individual claims to intermediary systems using industry standard ANSI ASC X12N 837 transactions (institutional, professional, and dental) and loads information about claim status back using industry standard ANSI ASC X12N 277 or 277CA transactions. This interface updates the status of errored claims in the system. Current integrations include...
  • Availity
  • Change Healthcare (RelayAssurance Plus)
  • ClaimLogic
  • Experian Health
  • Healthcare IP
  • nThrive
  • Quadax
  • The SSI Group
  • WayStar

Incoming Claim Acknowledgement

This incoming interface loads claim acknowledgement responses using industry standard ANSI ASC X12N 277CA, 999/997/TA1 or 277U transactions. Current integrations include...
  • Availity
  • Change Healthcare
  • Cirius
  • ClaimLogic
  • ClaimLynx
  • Experian Health
  • GatewayEDI
  • Healthcare IP
  • nThrive
  • Optum
  • OS inc
  • Quadax
  • Recondo
  • RelayHealth
  • SSI
  • WayStar

Claim Status Query

This bi-directional real-time interface sends requests and receives responses from payors and intermediary systems about claim statuses using industry standard ANSI ASC X12N 276/277 transactions. Epic uses web services to send and receive the X12 messages. Current integrations include...
  • Availity
  • Experian Health
  • RelayHealth

Incoming Health Care Claim Payment/Advice

This incoming batch interface posts insurance claim payment information received directly from payers and content aggregators, such as claims clearinghouses and banks, using standard ANSI ASC X12N 835 transactions. Current integrations include...
  • Availity
  • Bank of America
  • Change Healthcare
  • Chase
  • Cirius
  • ClaimLogic
  • ClaimLynx
  • Experian Health
  • Fifth Third
  • GatewayEDI
  • Healthcare IP
  • nThrive
  • Optum
  • OS inc
  • Patientco
  • PNC
  • Quadax
  • RelayHealth
  • SSI
  • US Bank
  • WayStar
  • Wells Fargo

Incoming Self-pay Payments read the specRead the technical specs

This incoming batch interface posts self-pay and bad debt payments in a configurable flat file format.

The flat file format is configurable, but the above common specification is pre-configured in the Foundation System for Epic customers and widely used with success. Current integrations include...
  • Bank of America
  • Chase
  • Fifth Third
  • Patientco
  • PNC
  • US Bank
  • Wells Fargo

Outgoing Pharmacy Claim Adjudication Query

This National Council for Prescription Drug Programs (NCPDP) query is used to determine how much a patient’s drug benefit plan is going to cover and how much the patient is required to pay for a specific medication. The adjudication query is sent to a centralized switch vendor which then routes the message to the appropriate pharmacy benefit manager (PBM) to determine coverage. This applies only to organizations using Epic's outpatient pharmacy module, Willow Ambulatory. Current integrations include...
  • Emdeon
  • RelayHealth

Claims Editing Interface (OptumInsight iCES)

Bidirectional claim code editing interface to the OptumInsight iCES code editing product. A code editor is used to scrub a submitted claim and check for errors in coding. Tapestry can then make automatic edits to the claim or hold it for manual review.

Paid Claims Import read the specRead the technical specs

Paid claim data can be imported into Epic to support population health and care management workflows by reconciling the data with the rest of the comprehensive medical record. This format is recommended when the data is can be manipulated or the extract is flexible to simplify the process of importing into Epic. Current integrations include...
  • Health Data Innovations
  • Milliman