Payer Information

Candid Health supports most EDI payers (these are listed in the Payers application as “Insurance Payers”). You can find a list of supported payers with their respective payer_id, primary_name, ‘availity_claims_professional_id’, and ‘availity_claims_institutional_id’ here.

The payer_id and primary_name should be used in the payer_id and payer_name fields of the subscriber’s insurance card information and when you use the Encounters endpoint.

When denoting a claim as self-pay, please use the responsible party field on the Encounters endpoint.

If your organization uses Payer Plans (previously named Payer Plan Groups, which is still reflected in the API), you can omit payer_id and payer_name. Instead, pass the payer_plan_group_name and set emr_payer_crosswalk to PAYER_PLAN_GROUP. The subscriber’s payer information will be automatically populated based on your configured Payer Plan settings. Encounters created with an unconfigured Payer Plan name will be routed to a queue where you can configure the Payer Plan.

If your organization does not use Payer Plans, you cannot create (POST), update (PUT), or delete them on your organization’s behalf, but you can still retrieve (GET) via API. To support Payer Groups and simplify future transitions, Candid automatically provisions backend Payer Plans that map 1:1 with Candid’s EDI/Insurance payers. These will remain immutable until you have been given full access to the Payer Plans feature.

All organizations have access to Payer Groups, which are configurable groupings of Payer Plans. For organizations not using Payer Plans, these are built directly from the default backend Payer Plans that map 1:1 to Candid’s EDI payers.