Software Integration Technology with Apex EDI
Please decide which products interest you most for integrating with your Practice Management Software.
Apex Developer Claims Tutorial
This tutorial is to help guide prospective partners how to integrate with Apex EDI. As you follow this tutorial, you will be guided through integration options. You will be presented with choices for integrating with Apex EDI. Please note the options of most interest to you.
Apex has dedicated many resources to developing a true environment for direct claims integration. Although we are never finished with our improvements, we hope you can:
- Gain from our vision, the functions of an integrated service with your software.
- Integrate with us quickly and “how to” make improvements with our consistent developments and feature releases.
- Improve your product and to sell more quality services with our integrated services.
- Provide us with your wish list and product enhancement requests.
We look forward to working with you and hope to speak with you soon!
Please select the module for review:
- Claims Format
- Claims Upload
- Managing Claims Response
- Claims 277 – Coming Soon!
- Claims EOB Data – Coming Soon!
We will need to know the claims format you will be sending. There are a few formats which are “standardized” and allow for quickest integration. The quickest formats include:
- Prepare an ANSI 5010P or 5010D
- This requires you to use the industry standard guidelines from WPC-EDI.
- Pros: Assuming you have purchased these Schemas guidelines, programmed according to specs, and understood this process, you will have the industry standard for processing claims and receiving payer remittance files. These standards have copyright and can be purchased direct from WPC
- Cons: Requires you to have a complete claims understanding and knowledge to follow the ANSI spec guidelines.
- Sample ANSI 5010P
- Sample ANSI 5010D
- Apex XML Claim File – In Development!
- Sample XML/JSON File Medical (Coming soon!)
- Sample XML/JSON File Dental (Coming soon!)
- Apex Print Image
- This requires you to use the Apex print image format. Create a plain text file or stream to match the Apex Print Image format. (see Apex samples)
- Pros: Quick integration. The Apex print standard, allows you to create a file that Apex can use to process claims. Apex will convert the txt file and send to the payer in the ANSI format. You must follow the formatting of the Apex print standard to include consistency on each claim and account for each line item or value, even if the data from claim to claim is present/not present. Failure to follow this standard, will produce shifting data and claim values, which will not be read in appropriately.
- Cons: If your software does not produce the ANSI 5010 file, it may not have the ability to post ERA files produced by the payer.
- Sample Medical Print Image
- Sample Dental Print Image
- Apex PDF Format
- Apex OCR technologies – print claim file to PDF from software for Apex OneTouch App upload.
- Proprietary request
- If you have one, let us know! We will do our best to accommodate!
After deciding the format of your claims, we need to know how we’re going to connect. Please choose from the following options.
- Apex Webservices – Claims “submit” is embedded into your software process. Your software has a direct connection to upload claims to the Apex database. You can connect direct to Apex via:
- a. Rest In Development!
- b. Soap In Development!
- c. HTTP POST/GET
- Apex OneTouch App – Proprietary application that Apex will provide to each of your users. The app will be installed and configured by Apex customer service to retrieve the recent claim file and auto-upload the claim file to Apex EDI.
- Pros: Ready to go, we just need to ensure compatible claim files. The office does not need to manually navigate to claims file and upload to the Apex website.
- Cons: The upload and submittal process is not embedded into your software process.
- File Upload to the Apex claim website
Send username & Password
Whenever you make any call that requires a username and password, it works best when you store the username and password wherever you store your location information.
Multiple locations & Site ID’s
Multiple site ID’s are used to manage different user locations, tax id’s, and multiple claims databases in a single upload.
Multiple Site ID’s are managed through passing the username and password on a location level through the claim file. For this to work you need to store the Apex username and password at the location level in your software.
Managing Claims Response
The options you can provide to your clients for managing claims include:
- SOAP responses, use this information to update your software with claim responses & validations.
- Pros: This information can be shared with you for software integration.
- Cons: Requirs programming knowledge
- REST responses, In Development!
- Apex claims portal – Each of your clients will be provided with an Apex web-based account for managing claims, failures, resubmits, and payer responses/reports.
- Pros: This is ready for your clients today. The portal is branded with your branding to include your logo and colors. As this portal is web-based, you may choose to open this in a frame within your software. This claims portal is accessible from any available internet connection.
- Cons: The user will leave your software for managing their claims.
Claims Response Status (Failed, Ready, Processed, Duplicate)
This process will update you of the Apex claim status and scrub edits. The Pass/Fail response is available to update your software.
- REST responses, In Development!
Claims Validation (Synchronous) & Resubmit
This process will update you of the individual errors per claim. The claim validations are available to update your software and the individual claim status. The claim can be resubmitted and replaced from your software.
- Soap, In Development!
- Import/Resubmit claim
- Delete claim
- Get (single) medical validation message
- Get (multiple) medical validation message
- REST responses, In Development!
- Eligibility Verification
Eligibility requests can be made from your software or from the Apex claims portal. The Apex portal can be branded with your private label and is a manual process for verifying patient eligibility. Users will enter patient information and receive information responses via this eligibility portal.
Automated Eligibility Calls
Eligibility calls can be made directly from your software. Eligibility results can be consumed and posted to your software. Apex partners have automated this to check patients eligibility from the schedule the day before the workload.
Receiving eligibility information allows software to display this information directly to the daily schedule, improving available data and processing of patient at the time of “check in”. You may also consider to log this info to the patient ledger for billing accuracy.
The steps for consuming Apex eligibility are:
- Get the Apex provider ID for the account that is being used (username & password).
- Get the eligibility payers list from Apex.
- Call the submit eligibility with the required parameters specified here.
- Store the return value from submit eligibility, that will be used as a parameter in the following call (Step 5)
- Call the get eligibility response.
- To submit batch eligibility, repeat the steps for each eligibility request
- Patient Statements
Automated Patient Statements
The processing of statements can be automated to electronically send from your software. As the office generates their aging reports and decide which amounts are owed by patients. These values can auto-process through Apex statements and be mailed to patients.
To process statements with Apex EDI, your software must provide the values to create the patients statements. Once uploaded to the Apex portal, statements can be reviewed, edited, and submitted for sending. Additionally offices can search and review statements via the Apex portal. View sample statement.
To automate statements you must decide on the upload method and the statement format to send to Apex.
Acceptable Apex formats include:
- Statements can be uploaded directly from your software via the Apex statement API upload process.
- Statements can be uploaded to Apex via Apex OneTouch application. The Apex OneTouch application is loaded to the users machine. After the statements are batched and created by your software, the application will “auto-upload” the statement file – from its file location.
- Payer Reports and Responses
Payer Reports and Responses
Payer reports can be received for a few purposes.
- To retrieve ANSI 835 Machine readable reports for “auto-posting” to patients ledger
- To retrieve and display EOB “PDF” reports to your software. All reports are formatted in a “human” readable PDF to display in your software for billing purposes.
- The next two processes work together.
- GetUnviewedERAMFiles and GetUnviewedFiles are used to get a list of files that need to be viewed. From the list, a filename can be pulled and GetFileByName is used to download the file.
- MarkFileAsViewed is then called to ensure the file is marked as viewed and will show in future calls to view an unviewed file list.
- Get unviewed files (human readable)
- Get unviewed ERAM files (ANSI 835)
- Mark file as viewed
- Get file by Name Coming Soon!
- Claims 277 Coming Soon!
- Get all ERAM files by date range Coming Soon!
- Get list of files by ID (all files by username & password give back 835 in xml and json) Coming Soon!
- Get file by vendor ID (all files by username & password give back 835 in xml and json) Coming Soon!
This process will allow you to pull list of Apex payers to populate your software
- Programming Languages,
Making 1st Call
Programming Languages, Code Snippets, and Making Your First Call
The most common languages to interface with Apex are: Java, C#, and .Net. Apex provides code snippets for these common programming languages to assist in consuming the Apex services.
To make the 1st call, you will need to request an Apex Demo account and have an assigned username and password for making the call. Click Here to receive demo account.
Available code snippets.
- Enrollment Process
The Enrollment Process
As an Apex partner we will handle the steps for provider enrollment. You can feel assured we will take care of the clients enrollment as we assist all new clients to complete enrollment with payers through these steps:
- Immediately after registration with Apex, the client is sent the enrollment link for enrollment registration.
- Client fills out the payers and follows the “Enrollment get started process” link.
- Apex enrollment team follows up with client 24-48 hours after. The Apex enrollment team verifies:
- Accuracy of the information the client has submitted
- Ensures proper completion of the enrollment forms and accuracy of provider numbers
- Apex Enrollment team follows up with the payers to:
- Verify the receipt of the providers enrollment forms
- Verify the payers responses
- Monitor progress of enrollment requests and rejections, and resubmission of requests with payers
- Apex enrollment team verifies the final enrollment success and will notify the providers office of successful completion.
- For enrollment questions, please contact us at email@example.com Please include the clients Name, Phone, and if possible the Apex client ID number.
Note: When referring a client to Apex, we will handle the enrollment. Please encourage the office to register for Apex services and know that we will handle enrollment through the automated Apex process.
Note: Medicare, Medicaid, BCBS require enrollment processing timelines of 6-10 business days to process enrollment. Depending on the state/region this may vary. Apex will help the office to understand enrollment timelines and expectations upon registration with Apex. For best results, please have the client articulate their enrollment timeframes at time of registration. Apex sales and enrollment departments do their best to alleviate any lapse of claims processing due to enrollment processing. We cannot guarantee timelines or processing by the payers, however we have a great track record and are dedicated to assisting providers in the enrollment process.
- Invoicing Options
Apex Invoicing Options
Our goals include supporting your organization with a complete integrated claims service. Currently the two methods we support of invoicing are:
Billing Option 1. Apex will bill your client for claims services and remit a “rebate” to you based on clients subscription to Apex eClaim services. Rebate checks are sent to you monthly from the Apex Accounting office. See below for available wholesale pricing options. (These rates are wholesale, you must decide the margins you wish to include – which will be billed to the providers)
This option allows you to offer a wider range of pricing based on current Apex invoicing options. You can offer either flat per provider pricing or pricing based on the office claim volume. All pricing includes unlimited eligibility verification requests and unlimited payer ERA responses.
$80 $99 $105 Yes Yes Yes $0 $250 50 Claims
$20 $30 $35 Yes Yes No $0.48 $250 100 Claims
$45 $60 $65 Yes Yes No $0.48 $250 200 Claims
$80 $99 $105 Yes Yes No $0.48 $250 500 Claims
$150 $185 $200 Yes Yes No $0.38 $250 1,000
$250 $305 $325 Yes Yes No $0.33 $250 2,000
$475 $570 $610 Yes Yes No $0.32 $250 5,000
$1,175 $1430 $1675 Yes Yes No $0.31 $250 10,000
$2,250 $2750 $3215 Yes Yes No $0.31 $250
Billing Option 2. If you currently choose to invoice your clients, Apex can bill you a monthly fee for each provider you bill. This system is currently based a per provider subscription rate of $80 monthly per provider. This subscription rate includes unlimited claims, eligibility verification requests, and unlimited payer ERA responses.
- Customer Support
& Private Label
Customer Support and Private Label
For partners, Apex handles customer service requests for electronic claims. We assist clients to understand “how to” interact with payers to dispute claims and to get paid. Additionally Apex clients are provided with a private labeled claims portal for tracking claims.
The branding of a private labeled claims portal is available to all Apex partners. We label the portal with your logo and color scheme. Powered By Apex is clearly labeled for clarification of the customer support provided by Apex to your clients.
This portal allows office to view failed claims and correct the claims from the portal. The error status is generated to assist the office to correct the claim.
After the claim is processed the payer replies with an insurance report for the office to verify the payers receipt.
As the payer processes payment the electronic 835 is generated to the office for final claim status of processed/failed. The portal will provide the Apex ERA for import for the office to download/import to your software.
The port also provides the office with the 835 – PDF for viewing report status.
Any statements loaded from your software can be viewed on the portal for final editing. Offices can decide what statements they mail, hold, delete, or adjust the statement contents before releasing to the mail. Apex will then mail the statements within 24 hours for processing to the patient. Statements are mailed with return envelope and return card addressed to the practice.
Apex Help Center is available for the portal to direct claims support. Apex reps are available for assistance via the following:
- Online Help Center
- (800) 840-9152
- Developer Support
Apex Development Support
Apex developer support can be reached Monday through Friday from 8:00 AM to 5:00 PM Mountain timezone:
- Email: firstname.lastname@example.org
- Skype: apexedi
- Phone: (801) 642-0333
With Apex EDI, you can set yourself apart from the competition by offering an easier, less expensive option for electronic claims processing. Here are some reasons Apex EDI makes sense for your business:
- Add value to your customers’ practices by providing access to more healthcare payers, lowering the cost of processing electronic claims and offering more tools for processing, tracking, and managing electronic claims
- Offer your customers a variety of additional services such as electronic patient statements, patient eligibility, and paper claims processing
- Improve your bottom line with a generous ongoing rebate program
- Turn ongoing support for your customers’ electronic claims processing solution over to our competent and friendly support staff
- A direct integration offers your customer a seamless user experience
If you are interested in becoming a technology partner or reseller, please call us at 800-840-9152 for further details.
Apex EDI is focused on providing quality services and exceptional support to our clients and partners. We value our relationship with our partners and work together to make sure that our mutual clients are not only satisfied but receiving the best service possible. To show our appreciation to our partners we offer:
- A generous and customizable revenue sharing program for each service utilized by your clients
- A variety of co-branded marketing materials that can be printed or emailed to your existing and potential clients
- Fast, friendly, and free customer support to help solve client issues or concerns
- Automatic compliance updates so that your clients never have to worry about expensive or time-consuming upgrades
- Free training on all services offered by Apex EDI
- A secure partner portal which gives you access to marketing materials, instant access to support, and custom reports showing you activity for each of your clients.
Our promise to you is that Apex EDI will always offer state of the art services and support so that you and your clients are always satisfied. Becoming an Apex Preferred Solutions Partner is easy and will provide you with a growing stream of monthly income based on the level of activity for each of your clients. Our system is compatible with virtually any practice management software, and our knowledgeable support staff is always standing by to answer questions and work through problems. For more information, please contact us at 800-840-9152.
- Request Demo
Request a Partnership Demo
Want to know how your company can add electronic claims billing functionality to your product suite in as little as two weeks? We’ll show you how. Please complete the form below to schedule a demo.
- Services Info
Apex EDI provides all the tools and services you need to make electronic claims processing easy, practical, and inexpensive. This includes:
A complete electronic claims processing system
Apex gives you access to more than 1,200 insurance companies, so your customer can process more claims electronically. Your customers will pay one low monthly fee to process an unlimited number of electronic claims. The Apex system works flawlessly with virtually any practice management software, and through a full integration, your customer will submit claims and receive reports directly through your software system. Apex turns the process of submitting electronic claims into a simple 2-minute operation performed one time each day. This easy, flexible approach to electronic claims processing can save your customers thousands of dollars and hundreds of hours every year.
Online claims tracking
A secure, easy-to-use web interface makes it easy to find and view the latest information about the status of all claims. With Apex, the information you need is never more than a few mouse clicks away.
Our online eligibility product helps your practice save time and money by helping you determine what will be covered by the insurance payer before you see the patient. Using our online eligibility tool will help reduce the time it takes to verify benefits, reduce the number of rejected claims and denials, and improve cash flow by determining and collecting the patient’s portion at the time of service.
The Apex system makes it easy to generate and print clear, professional statements complete with postal bar coded envelopes. With just a few simple steps statements can be generated every day so your customers can receive patient payments more quickly. In addition, once all of the hidden costs of printing and mailing statements in house are identified (paper, toner, envelopes, stamps, and the time spent printing, folding, stuffing, and mailing), it’s easy to see that your customers will recognize a significant cost savings in sending statements electronically. Click hereto see a sample statement.
Automated Electronic Payment Processing
Apex EDI offers a convenient electronic payment service that makes it easier and much less expensive to collect payment from patients. With this convenient solution your customer can set up automatic electronic payment plans, receive online payments, and even accept check-by-phone payments. This dramatically improves collections and reduces the time spent chasing down delinquent payments. Best of all, the whole system is web-based, so your customer can enjoy all the advantages of electronic payment processing from any computer with an internet browser.
With Apex, x-rays, notes, charts, and pictures can be sent electronically to participating insurance companies. This accelerates the claims process, saves time and money, and allows payments to be processed more quickly.
Apex EDI has teamed up with NEA FastAttach™, the industry leader in electronic attachments. NEA FastAttach enables healthcare providers to transmit attachments that go along with electronic claims to payers via the internet. Attachments include x-rays, perio charts, intra- oral pictures, EOB’s, lab reports, narratives, and a variety of other documents.
Paper claim processing
If your customer works with insurance companies that don’t accept electronic claims, Apex will print and send paper claims automatically. Simply submit all paper claims at the end of each day and we’ll do the rest.
Superior service and support
We understand that your customers expect a user-friendly way to submit claims and quick solutions to any issue that might delay payment. That’s why we’ve developed the easiest and friendliest electronic claims processing system in the industry—backed by competent, personalized service and support you simply won’t find anywhere else. Our approach is simple. If you run into problems we’ll do whatever it takes to fix them—quickly, professionally, and free of charge.
- Pricing Info
Apex EDI offers the highest possible value with one low monthly fee for processing an unlimited number of electronic claims. We invite you to compare our pricing with other electronic claims processing options—then choose the solution that makes the most sense for your customers:
- Pay a low one-time setup fee
- Process an unlimited number of electronic claims for one flat rate
- Process paper claims and generate patient statements for less than doing it in-house
- Receive all the ongoing technical support you need free of charge
For smaller practices that don’t submit a large volume of claims we also offer a lower block rate and a per claim rate. Please contact our sales team at 800.840.9152 for a free e-claims analysis to determine the best option for your customers.