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 Epic system sends the message. Incoming interfaces refer to interfaces in which the Epic system receives the message.

Outgoing Claims Status Request 276/277

Sends requests and receives responses from payers 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
  • Waystar

Outgoing Pharmacy Benefit Claims Adjudication Query read the specRead the technical specs

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

Outgoing Health Care Claims for Institutional, Professional, and Dental Services read the specRead the technical specs

This outgoing batch interface sends insurance claim information to payers 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

Incoming Claim Status - Flat File read the specRead the technical specs

This incoming batch interface loads information about claim status via a configurable flat file. This interface can update the status of claims in the system and is able to load claim error information from payer and intermediary systems.

The flat file format is configurable, but the common specification is pre-configured in the Foundation System for Epic customers and widely used with success.
Current integrations include...
  • Availity
  • Cirius
  • Change Healthcare
  • eSolutions
  • Experian Health
  • Healthcare IP
  • InstaMed
  • nThrive
  • Optum
  • Quadax
  • SSI
  • TriZetto Provider Solutions, a Cognizant Company
  • WayStar

Rapid Retest read the specRead the technical specs

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
  • Experian Health
  • Healthcare IP
  • nThrive
  • Quadax
  • The SSI Group
  • TriZetto Provider Solutions, a Cognizant Company
  • WayStar

Incoming Health Care Claim Payment/Advice read the specRead the technical specs

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

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