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 specIncoming Healthcare Claim Repricing Request (X12 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 Authorization Request as Notification - 278R read the specOutgoing Authorization Request as Notification - 278R technical specification

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.

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
  • Bright Health
  • Navitus
  • 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.

Tapestry Incoming Additional Information for Health Care Claim - 275

Receives electronic attachments and links them to Tapestry claims.

Outgoing Healthcare Claim: Professional (X12 837 Batch) read the specOutgoing Healthcare Claim: Professional (X12 837 Batch) 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.
Current integrations include
  • Change Healthcare
  • Gateway
  • McKesson
  • Santa Clara County (CA) - Public Health Agencies
  • Texas Medicaid & Healthcare Partnership

Incoming Healthcare Claim: Professional (X12 837 Batch) read the specIncoming Healthcare Claim: Professional (X12 837 Batch) technical specification

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

Outgoing Healthcare Claim Payment/Advice (X12 834 Batch) read the specOutgoing Healthcare Claim Payment/Advice (X12 834 Batch) 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
  • Utah - Public Health Agencies

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 (X12 834 Batch) read the specIncoming Benefit Enrollment and Maintenance (X12 834 Batch) 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 Claim Status Inquiry (X12 276) read the specIncoming Claim Status Inquiry (X12 276) 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.
Current integrations include
  • Change Healthcare
  • Tridiuum

Incoming Payment Order/Remittance Advice (X12 820 Batch) read the specIncoming Payment Order/Remittance Advice (X12 820 Batch) technical specification

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 Batch) read the specOutgoing Benefit Enrollment and Maintenance (X12 834 Batch) 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 Verification Query (X12 270/271) read the specIncoming Eligibility Verification Query (X12 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
  • Availity
  • Change Healthcare
  • HDX
  • Post-n-track
  • Relay Health
  • TransUnion

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 Unsolcited Healthcare Claim Pending Status Notification (X12 277P) read the specOutgoing Unsolcited Healthcare Claim Pending Status Notification (X12 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).
Current integrations include
  • Cigna
  • Evicore
  • Magellan

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
  • Natus
  • TriZetto Provider Solutions, a Cognizant Company
  • United Healthcare

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.

Tapestry Outgoing X12 Acknowledgment (X12 999) read the specTapestry Outgoing X12 Acknowledgment (X12 999) 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.

Tapestry Outgoing Front-End Claim Status Acknowledgment (X12 277CA) read the specTapestry Outgoing Front-End Claim Status Acknowledgment (X12 277CA) technical specification

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

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.

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

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 specTapestry Generic Code Editor technical specification

Bi-directional claim code editing integration with Tapestry