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.
This bidirectional interface is used for claim code editing.
This bidirectional interface analyzes claims to determine which DRG codes and prices are appropriate.
This bidirectional interface analyzes claims to determine which APC codes and prices are appropriate.
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.