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

Tapestry Incoming Health Care Claim: Repricing Request - 837 read the specTapestry Incoming Health Care Claim: Repricing Request - 837 technical specification

Tapestry receives incoming claim repricing requests through ANSI ASC X12 837 transactions.

Real-time 837 External Pricing read the specReal-time 837 External Pricing technical specification

Epic's managed care system supports pricing claims in real-time by sending the 837 and receiving a response of a repriced 837 with HCP Segments.

Outgoing Health Care Claims read the specOutgoing Health Care Claims technical specification

Sends professional claim information to payers. The 837 transmits claim information either for the purpose of payment, such as a provider sending a bill to a payer, or for the purpose of reporting, such as a delegated risk payer sending payment information to a health plan or the government.

Health Care Claims - Incoming 837 read the specHealth Care Claims - Incoming 837 technical specification

Tapestry receives incoming professional, institutional, or dental claims through ANSI ASC X12 837 transactions.
Current integrations include
  • Availity
  • DSG (Data Systems Group)
  • McKesson
  • Smart Data Solutions
  • Waystar

Outgoing Health Care Claim Remittance Advice - 835 read the specOutgoing Health Care Claim Remittance Advice - 835 technical specification

Sends claim payment and remittance information to health care providers. The 835 lets providers know which claims are paid and whether there is any difference between the payment amount and the billed amount. This is a batch interface.
Current integrations include
  • DSG (Data Systems Group)
  • McKesson

Outgoing Health Care Claim Code Editor read the specOutgoing Health Care Claim Code Editor technical specification

Bidirectional claim code editing interface that can work with various external systems.

Outgoing Health Care Claim Grouper and Pricer read the specOutgoing Health Care Claim Grouper and Pricer technical specification

Bidirectional interface that analyzes claims to determine which codes and prices are appropriate, and can work with various external systems.

Incoming Benefit Enrollment and Maintenance - 834 read the specIncoming Benefit Enrollment and Maintenance -  834 technical specification

Receives enrollment information from employers or other sponsors of coverage. Health plans and employers send 834s to inform a payer about members who are being enrolled in the payer's insurance plan or for whom the payer is otherwise taking on risk.

Incoming Health Care Claim Status - 276/277 read the specIncoming Health Care Claim Status - 276/277 technical specification

Receives requests from health care providers for status information about claims, including whether the claim was paid or unpaid and why. Tapestry supports the batch interface by default, with a real-time interface available.

Incoming Payment Order/Remittance Advice - 820 read the specIncoming Payment Order/Remittance Advice - 820 technical specification

Receives payment and remittance information. Tapestry supports an incoming 820 for the purpose of posting payment information against premium billing accounts.

Tapestry Outgoing Benefit Enrollment and Maintenance - 834 read the specTapestry Outgoing Benefit Enrollment and Maintenance - 834 technical specification

Sends enrollment information to health plans, government agencies, or other entities. Payers send 834s for reporting purposes to list all members for whom they have taken on risk.

Incoming Eligibility, Coverage, or Benefit Inquiry - 270/271 read the specIncoming Eligibility, Coverage, or Benefit Inquiry -  270/271 technical specification

Receives requests from health care providers for member eligibility and benefits information in the form of a 270, and sends a response in the form of a 271. This is a real-time interface.
Current integrations include
  • Change Healthcare
  • HDX
  • Post-n-track
  • Relay Health

Incoming Referral Request for Review - 278R read the specIncoming Referral Request for Review - 278R technical specification

Receives a referral request from a provider or provider group so that Epic's managed care system can perform utilization management and approve or deny the service request. A response message is sent to inform the provider of the authorization decision.

Outgoing Health Care Claim Pending Status Notification - 277P read the specOutgoing Health Care Claim Pending Status Notification - 277P technical specification

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 payer.

Incoming Authorization Notification - 278N read the specIncoming Authorization Notification - 278N technical specification

Receives unsolicited, completed referral information (usually with authorization numbers) from an external utilization management system so that Epic' Managed Care system can pay Accounts Payable (AP) claims. Sends an acknowledgment of the receipt of the information (or errors if any occur during message processing).

Outgoing Authorization Notification - 278N read the specOutgoing Authorization Notification - 278N technical specification

Sends authorization decisions for covered patient referrals to third-party AP claims systems. The response from the third-party AP claims system is the acknowledgement of the information received.
Current integrations include
  • TriZetto Provider Solutions, a Cognizant Company

Outgoing Health Care Data Reporting Claims read the specOutgoing Health Care Data Reporting Claims technical specification

This outgoing batch interface sends insurance claim information to government and intermediary systems using the industry standard ANSI ASC X12N 837 data reporting transaction.

Outgoing Health Care Claim Acknowledgement read the specOutgoing Health Care Claim Acknowledgement technical specification

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 read the specOutgoing Health Care Services Functional Acknowledgement technical specification

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 277CA Claim Acknowledgements read the specIncoming 277CA Claim Acknowledgements technical specification

Incoming Standard X12 format for loading Claim Acknowledgements.

Incoming Marketplace Benefit Enrollment and Maintenance (HIX 834) read the specIncoming Marketplace Benefit Enrollment and Maintenance  (HIX 834) technical specification

Standard X12 format for loading marketplace information.

Incoming X12 HIX 820 read the specIncoming X12 HIX 820 technical specification

Incoming Standard X12 format for loading Marketplace Premium Payment Information.

Monthly Premium Withholding Report (MPWR) read the specMonthly Premium Withholding Report (MPWR) technical specification

Transmits premium information to Medicare Advantage plans.

Outgoing Marketplace Benefit Enrollment and Maintenance (HIX 834) read the specOutgoing Marketplace Benefit Enrollment and Maintenance  (HIX 834) technical specification

Standard X12 format for sending out marketplace coverage information

Outgoing 1095-B (Simple) read the specOutgoing 1095-B (Simple) technical specification

The 1095-B is a flat file for tax information.

Outgoing 1099-MISC read the specOutgoing 1099-MISC technical specification

The 1099-MISC tax form is used to report miscellaneous income for Vendors from an AP Cycle processing.

Outbound Medicare Advantage and Prescription Drug System (MARx) files read the specOutbound Medicare Advantage and Prescription Drug System (MARx) files technical specification

File for reporting drug information between a health plan and CMS.

Tapestry Document Linker DMS Integration read the specTapestry Document Linker DMS Integration technical specification

This VB integration enables users in an external document management system to launch the Tapestry Document Linker activity in an active Hyperspace session and pass necessary document information to link a document to records in Epic. Additionally the integration can allow for users in the DMS to create new claim and CRM records in Hyperspace with links to the desired document.