Table of Contents:


Apex EDI has created a turnkey environment for direct claims integration. Although we are never finished with our improvements, we hope you can:

  1. Gain from our vision, the functions of an integrated service with your software.
  2. Integrate with us quickly and know how to make improvements with our consistent developments and feature releases.
  3. Improve your product and to sell more quality services with our integrated services.
  4. Provide us with your wish list and product enhancement requests.

Claims Format

We will need to know the claim format you will be sending. There are a few formats which are "standardized" and allow for rapid integration. The quickest formats include:

  1. ANSI 5010P or 5010D
    • This requires you to use the industry standard guidelines. (Available from WPC-EDI)
    • Pros: Programming to the 5010 spec will give you the most power and flexibility in your software.
    • Cons: Requires more development time.
    • ANSI format details
  2. Print Image
    • This requires you to use the appropriate professional or dental print image format.
    • Pros: Quick integration.
    • Cons: Format must be followed exactly because shifting data causes claims to fail, requiring corrections by client.
    • Print image format details
  3. PDF
    • Apex EDI can accept claims in PDF format. Preferably from the Apex Connex printer driver.

Claims Upload

After deciding the format of your claims, we need to know how you're going to connect. Please choose from the following options:

  1. Apex EDI Webservices
    • Claim submission is embedded into your software process. Your software has a direct connection to Apex EDI.
    • Pros: Seemless integrated experience for clients.
    • Cons: Requires more development time.
  2. Apex EDI OneTouch App
    • Proprietary application that Apex EDI will provide to each of your users. The app will be installed and configured by Apex EDI customer service to retrieve the recent claim file and 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 claim file and upload it to the Apex EDI website.
    • Cons: The upload and submission process is not embedded into your software process.
  3. Manual File Upload
    • Customers can use the Apex EDI web site to manually upload claim files.

Claims Status

This process updates you of the claim status. Claim status can be Failed, Ready, Processed or Duplicate. See GetClaimStatusByVendorClaimID for detailed explanations of each claim status.

The options available for making client aware of claim status include:

  1. Web Services
    • Use the available API methods to update claim status in your software.
    • Pros: Streamline your customer experience.
    • Cons: Requires development time.
  2. Apex EDI claims portal
    • Each of your clients will be provided with an Apex EDI 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 it within your software. This claims portal is accessible from any available internet connection.
    • Cons: The client may be required to leave your software for managing their claims.