Candid Health Integration
The RCM & Billing Decision Guide walks through requirements questions and FHIR modeling decisions for billing — charge capture, eligibility, claims, and remittance — use it alongside these docs.
Candid Health is a revenue cycle automation provider. This integration enables payer lookup, insurance eligibility checks, and professional medical claim submission directly from FHIR resources.
Claim Submission
Submit professional medical claims to Candid Health from a FHIR Claim resource. The integration handles mapping patient demographics, provider information, diagnoses, and service lines into Candid's API format.
Eligibility Check
Run real-time, pre-encounter insurance eligibility checks via Candid's pre-encounter API. Returns a FHIR CoverageEligibilityResponse with benefit details mapped from the payer's 271 response.
Payer Directory
Search Candid's payer directory or fetch a payer by its Candid UUID. Returns FHIR Organization resources with the payer identifiers and clearinghouse support details needed for claim submission and eligibility checks.