Apex EDI Developers

Table of Contents:

• Introduction
• Apex EDI Claims Portal Eligibility Request
• Integrated Eligibility Requests
• Apex EDI Eligibility API Methods

Introduction

Patient eligibility requests can be integrated directly into your software or can be done from the Apex EDI claims portal.

Eligibility Request Through the Apex EDI Claims Portal

Eligibility requests from the Apex EDI claims portal are performed directly through the Apex EDI claims portal. Clients will enter patient information and receive payer responses via the Apex EDI claims portal.

Integrated Eligibility Requests

Eligibility calls can be integrated directly into your software.

Apex EDI Eligibility API Methods

The Eligibility API methods should be used in the sequence outlined below.

1. GetProvider- This will give you the Apex provider ID for submitting the eligibility request.
2. GetEligibilityPayers - This will give you the payer ID for submitting the eligibility request.
3. SubmitEligibility - This will submit the eligibility request. You will need the provider ID, payer ID, username, password and patient data.
4. GetEligibilityResponse - This will return an eligibility response for a given request. You will need the return value from the SubmitEligiblity call.

To submit batch eligibility, repeat the steps for each eligibility request.