Financial

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

Managed Care

Epic provides a managed care product - Tapestry - for use by our organizations that provide a health plan for their patients. Their managed population may also be seen outside of their organization. These interfaces are specifically used when Epic's managed care software is in use.

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

Benefit Enrollment and Maintenance

Tapestry receives incoming enrollment information from employers or other sponsors of coverage through batched ANSI ASC X12N 834 transactions. Similarly, it sends enrollment information to entities needing the information through the same standards.

Eligibility, Coverage, or Benefit Inquiry

This bi-directional real-time interface receives and responds to inquiries about a member's eligibility and benefits. It uses ANSI ASC X12N 270/271 transactions. Epic exposes Web services to send and receive the X12 messages.

Health Care Services Review

This bi-directional real-time interface receives and responds to new referral requests. It uses ANSI ASC X12N 278/278 transactions. Similarly, Tapestry can provide unsolicited ANSI 278 notifications for single referrals.

Health Care Claim Status

This bi-directional real-time interface receives requests and sends responses to healthcare providers about claim statuses. ANSI ASC X12N 276/277 transactions are used. Epic exposes Web services to send and receive the X12 messages.

Incoming Health Care Claims for Institutional and Professional Services

Tapestry receives institutional and professional claims in batch from healthcare providers through ANSI ASC X12N 837 transactions. It sends claims in batch to payors using the same standard. Tapestry can also receive dental claims using this standard.

Outgoing Health Care Claim Acknowledgement

This outgoing batch interface sends claim acknowledgement responses to incoming ANSI 837 files using ANSI ASC X12N 277CA transactions.

Outgoing Health Care Services Functional Acknowledgement

This message is sent in response to incoming healthcare services messages. It acknowledges the receipt of the message and, if necessary, reports any formatting errors in the file. It is an ANSI ASC X12N 999 transaction.

Incoming Payment Order/Remittance Advice - 820

This incoming batch interface receives health insurance premium payment information using ANSI ASC X12N 820 transactions.

Outgoing Health Care Claim Remittance Advice

This outgoing batch interface contains claim payment information for health care providers. It uses ANSI ASC X12N 835 transactions. Batches can be provided via Web services exposed by Epic software.

Claims Editing

This bidirectional interface is used for claim code editing. Current integrations include...
  • OptumInsight iCES
  • McKesson CodeReview (in progress for ClaimsXten)

DRG Grouper/Pricer

This bidirectional interface analyzes claims to determine which DRG codes and prices are appropriate. Current integrations include...
  • nThrive
  • OptumInsight HSS EasyGroup

APC Grouper/Pricer

This bidirectional interface analyzes claims to determine which APC codes and prices are appropriate. Current integrations include...
  • OptumInsight HSS EasyGroup

Document Image Attachments

In this scenario, the user scans a document into an external document management system. The document is for an AP claim or CRM record. The DMS launches into the claim creation or CRM creation workflow in the EMR, as appropriate, and the scanned document is associated with the newly created record. For other types of scans, the DMS can launch Epic's Document Linker activity, which presents the user with the ability to link the scan to a patient, a referral, a benefit plan, an employer group, etc. Current integrations include...
  • Hyland OnBase
  • SunGard MACESS

Health Care Services Authorization Notification - 275/275 (bi-directional)

Sends and receives additional information corresponding to an outgoing 278/278 authorization notification. The 275 is for information that is not in the 278 standard.

Outgoing Health Care Claim Pending Status Notification - 277P3

Sends information to a health care provider about the status of all non-finalized claims received from that provider. The 277P is an unsolicited message that is similar to the 277 response to the 276. It is sent so that the provider doesn't have to continually send 276 requests to the payor. Current integrations include...
  • HealthCareIP