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.

Incoming Claim File Acknowledgment Interface – 999 read the spec

This incoming interface loads claim file acknowledgment responses using industry standard ANSI ASC X12N 999 transactions.

Current integrations include

3M
Cigna
FinThrive
Optum

Outgoing Additional Information for Health Care Claim (X12 275)

Sends additional information to support a Healthcare Claim from Epic's billing module, Resolute

Current integrations include

Blue Cross Blue Shield of Massachusetts
Cirius
FinThrive
Healthcare IP
Optum
Waystar

Outgoing Claims Status Request (X12 276/277) read the spec

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
Anthem
Availity
Change Healthcare
Experian Health
FinThrive
Healthcare IP
HealthPartners
NEHEN
Optum
Quadax
The SSI Group
TriZetto Provider Solutions, a Cognizant Company
Waystar

Outgoing Pharmacy Benefit Claims Adjudication Query read the spec

This real-time interface is used to determine what portion of a prescription's cost will be paid by the patient's insurance so that the patient can be charged appropriately for the prescription fill. Claim Adjudication uses NCPDP Telecommunication version D.0.

Current integrations include

Cardinal Health WaveMark
CenterX
Change Healthcare
CoverMyMeds
Fred IT Group
McKesson
Morris & Dickson
Optum
Relay Health
Rx Linc
Surescripts

Outgoing Health Care Claims for Institutional, Professional, and Dental Services read the spec

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

Availity
Carisk Intelligent Clearinghouse
Change Healthcare
Cirius
ClaimLynx
efficientC
Experian Health
Healthcare IP
Inovalon
nThrive
Optum
Quadax
SSI
TriZetto Provider Solutions, a Cognizant Company
WayStar

Incoming Claim Status Batch (Flat File) read the spec

This incoming batch interface loads information about claim status through 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
Change Healthcare
Cirius
eSolutions
Experian Health
Healthcare IP
Inovalon
InstaMed, a J.P. Morgan Company
nThrive
Optum
Quadax
SSI
TriZetto Provider Solutions, a Cognizant Company
WayStar

Rapid Retest read the spec

This bi-directional interface builds upon the use of standard Claim Reconciliation and 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 spec

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
BBVA
Change Healthcare
Cirius
ClaimLynx
efficientC
Experian Health
Fifth Third
Healthcare IP
Huntington Bank
Inovalon
J.P Morgan Chase
nThrive
Optum
Patientco
PNC
Quadax
Quadax
SSI
TD Bank, N.A.
Texas Capital Bank
TriZetto Provider Solutions, a Cognizant Company
US Bank
WayStar
Wells Fargo

Incoming Self-pay Payments read the spec

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
Fifth Third
J.P Morgan Chase
Patientco
PNC
Texas Capital Bank
US Bank
Wells Fargo

Paid Claims Import read the spec

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

Incoming Claim Status Batch (X12 277) read the spec

This incoming batch interface loads information about claim status using industry standard ANSI ASC X12N 277 or 277CA transactions. This interface can update the status of claims in the system and is able to load claim error information from payer and intermediary systems.