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.

Incoming Healthcare Claim Repricing Request (X12 837) read the spec

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

Outgoing External Repricing Request Query (X12 837) read the spec

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 Authorization Request as Notification (X12 278R) read the spec

Sends authorization decisions for covered patient referrals to third-party AP claims systems using the 278R format rather than 278N. Required by Texas Medicaid.

Current integrations include

Texas - Public Health Agencies

Tapestry Incoming Bank Reconciliation

Receives status updates for check records to match the status assigned by the bank responsible for distributing the check.

Current integrations include

Chase Bank

Tapestry Incoming Benefit Accumulations

Receives external benefit bucket information so that member cost responsibility can be calculated correctly when processing claims.

Current integrations include

Aetna
Navitus
Optum
United Healthcare

Tapestry Incoming Marketplace Benefit Enrollment and Maintenance

Receives eligibility information to create, term, and update Marketplace coverage information.

Tapestry Incoming Marketplace Premium Payment Information

Receives and processes premium payments associated with Marketplace coverages in Epic

Tapestry Outgoing Marketplace Benefit Enrollment and Maintenance

Sends marketplace coverage enrollment information government agencies or other entities.

Tapestry Outgoing Positive Pay Files

Sends check information for processed claims to banks as part of the claims payment cycle.

Current integrations include

Chase Bank

Tapestry Incoming Referral Transfer Attachment (X12 275)

Receives electronic attachments and links them to Tapestry claims.

Outgoing Healthcare Claim: Professional (X12 837 Batch) read the spec

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.

Current integrations include

Change Healthcare
Gateway
McKesson
Santa Clara County (CA) - Public Health Agencies
Texas Medicaid & Healthcare Partnership

Incoming Healthcare Claim: Professional (X12 837) read the spec

Tapestry receives incoming professional, institutional, or dental claims through ANSI ASC X12 837 transactions. Standard version is batch with a real time option in upcoming version.

Current integrations include

Availity
Change Healthcare
DSG (Data Systems Group)
Humata Health
McKesson
Relay Health
Smart Data Solutions
Waystar

Outgoing Healthcare Claim Payment/Advice (X12 835) read the spec

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, with a real time option available in an upcoming version.

Current integrations include

DSG (Data Systems Group)
McKesson
Utah - Public Health Agencies

Outgoing Health Care Claim Grouper and Pricer read the spec

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 (X12 834) read the spec

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 Claim Status Inquiry (X12 276/277) read the spec

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. Returns response (X12 277).

Incoming Payment Order/Remittance Advice (X12 820 Batch) read the spec

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

Outgoing Benefit Enrollment and Maintenance (X12 834) read the spec

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.

Current integrations include

MedImpact
Navitus

Incoming Eligibility Verification Query (X12 270/271) read the spec

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

Availity
Change Healthcare
HDX
Post-n-track
Relay Health
TransUnion

Incoming Referral Request for Review (X12 278R) read the spec

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.

Current integrations include

Johns Hopkins HealthCare LLC

Outgoing Unsolcited Healthcare Claim Pending Status Notification (X12 277P) read the spec

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.

Current integrations include

Incoming Authorization Notification (X12 278N) read the spec

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).

Current integrations include

Cigna
Evicore
Johns Hopkins HealthCare LLC
Magellan

Tapestry Incoming Referral Transfer Attachment (X12 275)

Receives electronic attachments and links them to claims in Epic's managed care product, Tapestry.

Current integrations include

MGC Diagnostics
Wolters Kluwer

Outgoing Authorization Notification (X12 278N) read the spec

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

Health Plan Services
Johns Hopkins HealthCare LLC
Natus
TriZetto Provider Solutions, a Cognizant Company
United Healthcare

Outgoing Health Care Data Reporting Claims read the spec

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 spec

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

Tapestry Outgoing X12 Acknowledgment (X12 999) read the spec

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.

Tapestry Outgoing Front-End Claim Status Acknowledgment (X12 277CA) read the spec

Tapestry Outgoing Front-End Claim Status Acknowledgment (X12 277CA).

Incoming Marketplace Benefit Enrollment and Maintenance (HIX 834) read the spec

Standard X12 format for loading marketplace information.

Incoming X12 HIX 820 read the spec

Incoming Standard X12 format for loading Marketplace Premium Payment Information.

Monthly Premium Withholding Report (MPWR) read the spec

Transmits premium information to Medicare Advantage plans.

Tapestry Outgoing Marketplace Benefit Enrollment (X12 834) read the spec

Standard X12 format for sending out marketplace coverage information

Outgoing 1095-B (Simple) read the spec

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

Outgoing 1099-MISC read the spec

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 spec

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

Tapestry Document Linker DMS Integration read the spec

We recommend using the Hyperdrive Document Linker instead of this technology. 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.

Tapestry Generic Code Editor read the spec

Bi-directional claim code editing integration with Tapestry

X12 278 Endpoint Specifications read the spec

Describes JSON Wrapped RESTful endpoint for sending and receiving X12 278 interface messages.