Integration Guide
Candid’s modern APIs are designed to be interoperable with the rest of the healthcare tech stack. Depending on your organizations 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 integrate with Candid, it is recommended to start with the Claim Submission required endpoints. These consist of Encounters and Service Lines: the core objects that enable claim submission.
Once you have successfully integrated these endpoints, you can explore additional endpoints based on your organization’s needs. These approaches will streamline your workflows and enhance your integration with Candid.
Practice Management
Candid’s Practice Management endpoints are designed to help you manage eligibility checks, patient data, insurance coverages, payer information, and appointments. These are strongly recommended for organizations looking to leverage Candid Health’s full capabilities.
This integration pattern is right for your organization if you want:
- Candid to be the source of truth for patient demographic and insurance data.
- The ability to leverage Candid’s eligibility checks for real-time insurance verification.
- Visibility into prior authorization and referrals tracking.
Alternatively, you can maintain this data in your existing systems, utilize your current eligibility solution, and use Candid for claim submission only.
Recommended endpoints for this pattern include:
Learn more about these endpoints in the Practice Management section below.
Data Exports
Candid Data Share enables your organization to pull raw encounter, service line, and financial transaction data from Candid. This enables you to leverage this data to power complex business and financial reporting logic.
This integration pattern is right for your organization if you want:
- Streamlined access to Candid’s data for reporting and analytics, especially for large-scale datasets.
- The ability to integrate Candid’s data with your existing data platforms.
Alternatively, you can export this data from the Candid web application in the Reports Section.
Recommended endpoint for this pattern is:
Learn more about this endpoint in the Data Exports section below.
Data Configuration
Candid’s Data Configuration endpoints allow you to manage contracts, credentialing, schedules, service facilities, and providers. This data to Candid is integral to maximizing the rules engine’s ability to ensure accurate claim submission and reconciliation.
This integration pattern is right for your organization if you want:
- To maintain contracts, credentialing, schedules, service facilities, and providers in an external system and automatically synchronize this data with Candid.
Alternatives
- If Candid is used as the system of record for this data, you do not need to integrate with these endpoints.
- All data can be manually or bulk uploaded to Candid via the web application; however, this requires manual intervention and has batch size limitations so is not recommended for large-scale operations.
Recommended endpoints for this pattern include:
Learn more about these endpoints in the Practice Data section below.
Patient Invoicing
Candid’s Patient Invoicing endpoints allow you to manage invoices, patient payments, and patient refunds. It is strongly recommended that all patient payments are posted into the Candid System in order to have a holistic view of your organization’s Accounts Receivable.
This integration pattern is right for your organization if you want:
- A streamlined process for managing patient payments and refunds.
- A comprehensive view of patient financial data and AR within Candid.
Recommended endpoints for this pattern include:
Alternatively, Candid partners with a variety of patient payment solutions, which replace the need to integrate with the Patient Invoicing endpoints.
Learn more about these endpoints in the Patient Collections section below.
Endpoints
Claim Submission
Primary object required in order to submit claims through Candid Health. Received Encounters flow through the automated Rules Engine to create and submit claims. Encounters can be created in full through the Encounters endpoint, or in combination with the Patient object through Create Encounter From Patient and Appointment endpoint.
Services rendered during an Encounter. Captures CPT codes, modifiers, quantity, etc.
Practice Management
Enables centralized management of Patient data from within Candid Health. Supports workflows such as insurance management, eligibility verification, etc.
Captures Patient insurance coverages for use in eligibility checks. Supports history of insurance coverage over time.
Access Candid Health’s Payer database in order to retrieve Candid Health’s representation of Payers. Commonly used to map external system representation of payers to Candid Health’s for use in other workflows, like Encounter creation.
Core component of Candid Health’s Practice Management System. Required if utilizing Candid for patient check-in workflows.
Pass-through to a partner’s real-time eligibility endpoint. Provides real-time eligibility information for insurance verification, co-pay collection, and other front-desk workflows.
Data Exports
Practice Data
Data for Contracts, Credentialing, Fee Schedules, Service Facilities, and Providers can be managed within Candid Health’s web application or synchronized with external systems via API.
Patient Collections
Import an invoice sent to a patient. If invoices are created by an external process, these should be imported into Candid Health in order to provide a holistic view of data relevant to accounting and balances. Invoices can be created natively within Candid Health via manual workflows within the web application or via automated processes. Invoices created within Candid Health can optionally trigger invoice creation in third-party payment collection systems, such as Stripe and Cedar.
Patient payments collected via an external process should be created within Candid Health in order to provide a holistic view of data relevant to accounting and balances. Patient payments collected via third-party partners integrated with Candid Health, such as Stripe and Cedar, automatically sync into the Candid Health platform.
Patient refunds issued via an external process should be created within Candid Health in order to provide a holistic view of data relevant to accounting and balances. Patient refunds issued via third-party partners integrated with Candid Health, such as Stripe and Cedar, automatically sync into the Candid Health platform.