Candid Health
This page is under construction and should not be used as reference material.
Candid Health is a revenue cycle automation provider, and this is a billing integration. This guide walks through the components of the integration. A successful implementation of the integration will enable the following scenarios:
- Ability to do a (basic) eligibility/benefits check for a patient
Coverage - Ability to check claim balance
- Ability to submit a claim
- Synchronize claim status with external systems through the aging process
Integration Set Up
Setup requires project linking or Organizations with the correct identifiers and metadata to your Medplum Project. Bots ando other automations should be added to enable integration.
On Demand Workflows
These workflows are triggered by new data or user action in an application.
| Trigger | Resource(s) Used | Outcome |
|---|---|---|
New Coverage created or updated | Coverage, CoverageEligibilityRequest, CoverageEligibilityResponse | CoverageEligibilityResponse populated with data and Task created in case of exception |
Claim created or target age | Claim, ClaimResponse | ClaimResponse populated with patient responsibility |
Encounter finalized post visit | Encounter, Claim | Encounter synchronized to external API and identifier added to original resource for recordkeeping |
Eligibility/Benefits Check
The eligibility and benefits check should be tightly scoped to the implementation and should synchronize the following data
- Check whether Coverage is in force, e.g. whether
30is active - Check whether Coverage is in network for service provider or not
- Plan specific benefits, deductibles if available.
Balance Check
Check and store balances. Data model TBD.
Claim Submission
Synchronize the finalized Encounter to the Encounter endpoint for Candid. A claim will be generated on the Candid side and included in the response. A copy of that Claim resources, with the appropriate identifiers should be saved to the Medplum process.
Daily Sync Job
Batch job run daily to synchronize all claims updated on that day including status and identifiers.
As part of the daily process the status of the claims created as part of submission will be updated for recordkeeping purposes.