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

Returns a repriced claim with pricing information.

Tapestry External PPS Claims Pricer Interface (Generic)

Sends claims to external pricer system.

Tapestry Outgoing Health Care Claim: Professional - 837 (batch)

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 837/277CA

Receives professional claims from health care providers. 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...
  • Availity
  • DSG (Data Systems Group)
  • McKesson
  • Waystar

Outgoing Health Care Claim Remittance Advice - 835

Sends claim payment and/or 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

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

Outgoing Health Care Claim Grouper and Pricer

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

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

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

Receives payment and/or 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 (batch)

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

Incoming Eligibility, Coverage, or Benefit Inquiry - 270/271

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 Health Care Services Review - 278/278

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

Outgoing Health Care Claim Pending Status Notification - 277P

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 Health Care Services Authorization Notification (Health Plan) - 278/278 (Bidirectional)

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 Health Care Services Authorization Notification - 278/278

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 Additional Information for Health Care Services Authorization - 275

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 Data Reporting Claims read the specRead the technical specs

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 specRead the technical specs

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 specRead the technical specs

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 specRead the technical specs

Incoming Standard X12 format for loading Claim Acknowledgements.

Incoming Marketplace Benefit Enrollment and Maintenance (HIX 834) read the specRead the technical specs

Standard X12 format for loading marketplace information.

Incoming X12 HIX 820 read the specRead the technical specs

Incoming Standard X12 format for loading Marketplace Premium Payment Information.

Monthly Premium Withholding Report (MPWR) read the specRead the technical specs

Transmits premium information to Medicare Advantage plans.

Outgoing Additional Information for Health Care Services Authorization Notification - 275/275 (Bidirectional)

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 Marketplace Benefit Enrollment and Maintenance (HIX 834) read the specRead the technical specs

Standard X12 format for sending out marketplace coverage information

Real-time 837 External Pricing read the specRead the technical specs

Tapestry supports pricing claims in real-time by sending the 837 and receiving a response of a repriced 837 with HCP Segments.

Outgoing 1095-B (Simple) read the specRead the technical specs

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

Outgoing 1099-MISC read the specRead the technical specs

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 specRead the technical specs

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