Financial

Exchange information about money that's due and money that's paid.

Referrals

Referrals interfaces are used to communicate information about referrals that can be used for insurance operations. Clinical data is communicated via our clinical interfaces.

In outgoing interfaces, the referral information is being sent to an external system.

Outgoing Authorization Inquiry (X12 278I) read the specOutgoing Authorization Inquiry (X12 278I) technical specification

Sends inquiries to clearinghouses and payers about existing authorization information for a patient and receives responses to those inquiries. Inquiries can originate from the referring organization, or from the referred to organization. This interface is often used in conjunction with the Outgoing Health Care Services Authorization Request - 278/278 interface.
Current integrations include
  • Anthem
  • Availity
  • Blue Cross/Blue Shield
  • Change Healthcare
  • Humana
  • Humata Health
  • Janus
  • Recondo
  • Rhyme
  • United Healthcare
  • Waystar

Incoming Referral Notification read the specIncoming Referral Notification technical specification

Receives patient referral information from an external system. The interface can create, update, and cancel referrals in Epic.
Current integrations include
  • CareDx
  • Change Healthcare
  • Crimson
  • Ensemble Health Partners
  • Fibroblast
  • HealthLink
  • Hyland
  • Proficient Health
  • Salesforce

Outgoing Referral Notification read the specOutgoing Referral Notification technical specification

Transmits patient referral information to an external system, such as when a primary care provider refers a patient to a specialist. This is an HL7v2 interface. Most often, referrals are sent with the X12 278 interfaces.
Current integrations include
  • Artera
  • Artera
  • Avinty
  • CipherHealth
  • CognisantMD
  • eHealth Technologies
  • Ensemble Health Partners
  • Fibroblast
  • Graphnet
  • HealthLink
  • Hyland
  • Irisoft
  • MedTek
  • New York Cancer & Blood Specialists
  • PowerHealth
  • Proficient Health
  • Salesforce
  • The Advisory Board
  • Well Care

Outgoing Additional Information to Support a Health Care Services Authorization Query read the specOutgoing Additional Information to Support a Health Care Services Authorization Query technical specification

Used in conjunction with an Outgoing Referral Request for Review - 278R, provides supporting clinical documentation for the request. Follows ANSI X12 specification 005010X211, ANSI X12 275 for Authorization, Additional Information to Support a Health Care Services Review (275)
Current integrations include
  • Anthem
  • Humana
  • Rhyme
  • Samaritan Health Plans
  • United Healthcare
  • Voluware

Incoming Additional Information to Support a Health Care Services Review - 275

Used in conjunction with an Incoming Referral Request for Review - 278R, provides supporting documents for the referral request. Follows ANSI X12 Specification 005010X211, ANSI X12 275 for Authorization, Additional Information to Support a Health Care Services Review.
Current integrations include
  • Johns Hopkins HealthCare LLC

Outgoing Authorization Request for Review and Response (X12 278R) read the specOutgoing Authorization Request for Review and Response (X12 278R) technical specification

Transmits patient referral or authorization information to a third-party system. The referral/authorization information is sent in order to obtain authorization for health care services (such as specialty referrals and procedures) with clearing houses and payers. It uses ANSI X12 278 transactions.
Current integrations include
  • AccuReg
  • Aetna
  • Allscripts
  • Anthem
  • athenahealth
  • Availity
  • Change Healthcare
  • Citra Health Solutions
  • Emblem
  • Ensemble Health Partners
  • Evicore
  • Experian Health
  • GE
  • Glidian
  • Health Care Service Corporation
  • Humana
  • Humata Health
  • Janus
  • Quartz
  • Recondo
  • Redox
  • Rhyme
  • Symplr
  • Texas - Public Health Agencies
  • United Healthcare
  • Voluware
  • Waystar

Outgoing Referral Inquiry (X12 278I) read the specOutgoing Referral Inquiry (X12 278I) technical specification

Provides the ability to inquire about the status of an existing authorization request. It uses ANSI X12 278 transactions and is used in conjunction with an Outgoing Referral Request for Review - Outgoing Request (X12 278R) interface.
Current integrations include
  • Blue Cross/Blue Shield
  • Change Healthcare
  • Humana
  • Olive
  • Recondo
  • Relay Health
  • United Healthcare
  • WayStar