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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.

TriggerResource(s) UsedOutcome
New Coverage created or updatedCoverage, CoverageEligibilityRequest, CoverageEligibilityResponseCoverageEligibilityResponse populated with data and Task created in case of exception
Claim created or target ageClaim, ClaimResponseClaimResponse populated with patient responsibility
Encounter finalized post visitEncounter, ClaimEncounter 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 30 is 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.