External API specifications

The following information applies exclusively to edgeMED’s web-based practice management software.

External API


Specifications

The following information applies exclusively to edgeMED’s web-based practice management software.

Objective

To list the capabilities of the edgeMED External API’s that are used to load external data into the edgeMED database (DB). In addition, list the data that can be loaded as scripts without using the API’s.

External API Modules

The following modules can be pushed over to edgeMED DB through the API’s.

All edgeMED solutions have API’s to do the below functionalities:

  1. Search

  2. Get

  3. Delete

  4. Save

The information that edgeMED can receive via API’s to Search/Save/Delete on all the modules include:

  • Payer

  • Referring Provider

  • Patient

  • People

  • Case

  • Encounters/Charges

The below modules have only "Save and Post “implemented as of now.

  • Patient Payments

  • Insurance Payments

View/Download the Microsoft Excel document explaining each API in detail:


Payer

All Payers that have an ‘ExternalReferencePayerId’ (Unique Payer ID) can be uploaded through the API. The electronic ID is mandatory if the payer’s claim filing is Electronic.

Referring Provider

Referring Providers from the external system can be loaded to edgeMED with an ‘ExternalReferringProviderId’ mapped to each record.

Demographics

Patient / Cases / People (relation) information can be uploaded through the API. All the data needs an ‘External_Id’ (Unique ID) to reference.

Encounters/Charges

*Only Un-billed encounters (charges) can be uploaded through the API’s. An Un-billed encounter is described as NO Claims or Payments created for that encounter (charge).

The API will load all the charge information like Patient, Case, Providers, Locations, Procedure Codes, Diagnosis Codes, Amount, and Units that are required for that encounter.

Patient Payments

Patient payments from the external system can be loaded to edgeMED by providing an ‘ExternalReferencePatientPaymentId’ which is unique. ExternalReferencePatientId, ExternalReferenceEncounterId, ExternalReferenceEncounterDetailId (in case the payment is at line item level) and ExternalReferenceEncounterChargeId (in case the payment is at miscellaneous charge level) also needs to be provided to identify the encounter and line item.

The patient payment API can be invoked only once the encounters which are part of the payment is imported into edgeMED unless the payment is at the patient level.

This API will import all patient level, line items level, and miscellaneous charges level payments into edgeMED.

Insurance Payments

Insurance payments from the external system can be loaded into edgeMED by providing an ExternalReferenceInsurancePaymentId which is unique. ExternalReferencePatientId, ExternalReferenceEncounterId and ExternalReferenceEncounterDetailId also need to be provided to identify the encounter and line item.

The insurance payment API can be invoked only once the encounters which are part of the payment is imported into edgeMED.

This API will import all line item level payments as well as any miscellaneous insurance payments into edgeMED.

*Reason for not loading billed encounters: When a claim is sent for an encounter, the clearinghouse will send back the status of the claim and the payment associated with it only to the Submitter of the Claim. A such, we cannot track that encounter in edgeMED, as it will not appear in any of the Revenue/Transaction reports.

Sequence to call the External API’s

The external API’s should be called in the following sequence:

  1. Authenticate - Authenticates the user/company and provides a Signature and Token that can be used in the following API’s

  2. Payer - Payer API will load the complete list of payers for the company

  3. Referring Provider – Loads the list of Referring Providers

  4. Patient – Loads the patient Information

  5. Cases - Loads the Cases information related to each patient

  6. People – Loads the relationships in the cases

  7. Encounters – Load the Charges for that patient

  8. Patient Payments* - Loads the payments made by the patient

  9. Insurance Payments* - Loads the payments made by the insurance

*The order of Insurance Payments and Patient payments should be in the same order in which they were added to the existing system.

edgeMED Scripts

There is no API to upload the financial history for a patient. Instead, we accept CSV or PDF files drafted for each patient that can contain the financial history for the patient. Below are the fields that can be included:

  • Total Adjustments on account

  • Total Charges on account

  • Total Insurance Payments to the account

  • Total Patient Payments to the account

  • Insurance Balance

  • Patient Balance

  • Total Balance

The CSV or PDF with the financial history will be uploaded as an attachment to the respective patient and the user can view it from Patient Dashboard, Profile, Encounter screen, etc.

Note: The financial data will not be reported in any of the Revenue/Transaction reports and they are accessible as a view-only PDF.

Additional Scripts that can be uploaded without API

The following are the data uploads that can be done without APIs. This data should be provided in an Excel sheet along with their External ID’s and we will run scripts to insert them into the edgeMED database.

  • Service Facility Locations

  • Procedure Codes

  • Diagnosis Codes

  • Fee Schedule