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.

Payer 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...
  • Aetna
  • Availity
  • Change Healthcare
  • Experian Health
  • NEHEN
  • nThrive
  • Optum
  • Quadax
  • The SSI Group
  • TriZetto Provider Solutions, a Cognizant Company

Prescription Claim Adjudication

This real-time interface is used to determine what portion of a prescription's cost will be paid by the patient's insurance(s), so that the patient may be charged appropriately for the prescription fill. Claim Adjudication uses NCPDP Telecommunication version D.0.
Current integrations include...
  • CenterX
  • Change Healthcare
  • Relay Health
  • Rx Linc
  • Surescripts

Health Care Claim Grouper and Pricer - Outgoing

Tapestry sends outgoing health care claim grouper and pricer requests through proprietary transactions.

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...
  • ABILITY Network
  • Availity
  • Carisk Intelligent Clearinghouse
  • Change Healthcare
  • Cirius
  • ClaimLynx
  • Experian Health
  • Healthcare IP
  • nThrive
  • Optum
  • OS inc
  • Quadax
  • SSI
  • TriZetto Provider Solutions, a Cognizant Company
  • 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.

External Edit Management 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
  • Change Healthcare
  • Experian Health
  • Healthcare IP
  • InstaMed
  • nThrive
  • Optum
  • Quadax
  • SSI
  • TriZetto Provider Solutions, a Cognizant Company
  • WayStar

Rapid Retest

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. See also our requirements for clearinghouse vendors supporting rapid retest.
Current integrations include...
  • Availity
  • Change Healthcare
  • Experian Health
  • Healthcare IP
  • nThrive
  • Quadax
  • The SSI Group
  • TriZetto Provider Solutions, a Cognizant Company
  • 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
  • ClaimLynx
  • Experian Health
  • Healthcare IP
  • nThrive
  • Optum
  • OS inc
  • Quadax
  • Recondo
  • SSI
  • TriZetto Provider Solutions, a Cognizant Company
  • WayStar

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...
  • Quadax
  • ABILITY Network
  • Availity
  • Bank of America
  • BBVA
  • Change Healthcare
  • Chase
  • Cirius
  • ClaimLynx
  • Experian Health
  • Fifth Third
  • Healthcare IP
  • nThrive
  • Optum
  • OS inc
  • Patientco
  • PNC
  • Quadax
  • SSI
  • TD Bank, N.A.
  • TriZetto Provider Solutions, a Cognizant Company
  • 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
  • BBVA
  • Chase
  • Fifth Third
  • Patientco
  • PNC
  • US Bank
  • Wells Fargo