Integration Guide
Candid’s modern APIs are designed to be interoperable with the rest of the healthcare tech stack. Depending on your organization’s tech stack and needs, an integration can be approached in many ways. This guide outlines the most common integration patterns and their supporting APIs, covering everything from simple claim submission to complex practice management systems.
Getting Started
To begin submitting claims through Candid, you will need to integrate with the Create Encounter API at minimum. All other endpoints are optional, and Candid’s implementation and delivery teams will work with you to determine other endpoints that should be built out based on your business goals.
Workflow Integrations
Claim Submission (required)
To submit claims to Candid, you should use one of the below Encounters endpoints. You should also integrate with the Service Lines endpoint to allow you to update your service line information via API.
The correct Encounter endpoint depends on a key decision about your integration: Will you be managing patient records and appointments within Candid?
Customers who manage patient records and appointments in Candid or create and update patient data and appointments in Candid rather than their EHR or practice management system. Review the Practice Management System section of the integration guide to learn more.
API Endpoint Decision Matrix
Use the table below to quickly find the recommended endpoint based on your answers:
Additional Information on Encounters
Do you want to send Candid encounter level metadata and write rules to leverage these data fields?
Custom encounter metadata enables you to write rules in Candid leveraging data fields that you are not sending over as part of your standard API integration and will not be part of the submission to the payer. Metadata can also be used as a reference field for your billing team as they work claims. More details can be found in the following Candid support articles: Configuration Guide: Custom Encounter Metadata and What is custom encounter metadata, and how do I implement it?
Do you want to send an attachment or supplemental information on claims?
Data Exports
Do you want to retrieve datasets out of Candid to use for financial reporting?
Candid Data Share provides you with a comprehensive and configurable data export solution of your claims data including the transactional history of every claim. This functionality is designed to enhance reporting capabilities, give you the tools you need to create your own reports, provide a clear financial record of a claim, and facilitate month-end close workflows. If you have a BI tool, Candid highly recommends using Candid Data Share.
You can directly pull the data from Candid’s BigQuery instance through a connector (such as FiveTran or Airbyte) into your BI or data lake instance. Candid’s Embedded UI reports also contain a Financial Transactions report powered by the Data Share model.
More details can be found in the following Candid support articles: What is the Candid Data Share, and How Do I Use it to Build Reports? and Candid Data Share: Tables and Definitions
Patient Invoicing
Do you manage patient invoicing externally from Candid?
Patient Invoicing Integration Guide - follow this guide to determine when a claim is ready to have patient balance collected and how to determine the correct amount to invoice the patient.
Integrating to this endpoint is required if you are managing patient invoicing completely outside of Candid.
To summarize, you should use the two below Patient AR endpoints that are purpose-built for patient invoicing.
Practice Management System
Candid offers a set of endpoints that cover practice management capabilities. These API endpoints fall under the bucket of our “Pre-Encounter” API endpoints.
Do you want to manage and maintain patient demographics information in Candid?
The patients and coverages endpoints unlock the ability to create and modify patient data and coverage information in Candid which automatically propagates to claims. This approach is beneficial for customers who need to manage patient data independently from claims. It also allows the pre-encounter eligibility check responses to be viewed in Candid rather than as an external JSON file.
Do you want to manage front-desk check-in workflows in Candid?
Sending appointments to Candid allows you to store patient appointment data in Candid. Your front desk staff can check-in patients for their appointments directly in Candid and view the list of scheduled appointments.
Do you want to check patient eligibility through Candid prior to the appointment?
Candid has a synchronous passthrough eligibility endpoint that uses Stedi that customers can use to check patient eligibility prior to their appointment. This endpoint returns the patient’s eligibility and benefits information response from the payer in both JSON and raw X12 EDI format (detailed by Stedi here). Candid charges a pass through cost for use of this eligibility endpoint. More details can be found in the following Candid support article, Transitioning to Candid’s New Eligibility Endpoint.
If appointments are stored in Candid, eligibility checks can run automatically. You can also manually run a check on a given patient in the Candid UI without building an integration
