Key Integration Flows - Swasth-Digital-Health-Foundation/hcx-platform GitHub Wiki

Key Integration Flows

As a Provider

  1. Once onboarded, use the Check Coverage Eligibility API to check the coverage eligibility of the patient (/coverageeligibility/check). Receive a response from the payer by providing /coverageeligibility/on_check callback API.
  2. Post eligibility check, you can pre-authorize the claim by calling the Pre-auth API (/preauth/submit). Receive a response from the payer by providing the /preauth/on_submit callback API.
  3. You can submit the actual claim by calling the Claim API. (/claim/submit). Receive a response from the payer by providing the /claim/on_submit callback API.
  4. Receive payment notification from the payer and acknowledge the same using the /paymentnotice/on_request callback API.

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Sample Postman collection to do these above calls is present in the Appendix Section

As a Payer

  1. Once onboarded, you will start receiving eligibility check requests from the provider. You can respond them using the /coverageeligibility/on_check callback API.
  2. Respond to the Pre-auth requests from the provider using the /preauth/on_submit callback API.
  3. Respond to the Claim requests from the provider using the /claim/on_submit callback API.
  4. Once payment is processed, you can send a payment notification to the provider using the Payment Notification API (/paymentnotice/request). You can receive the provider's response using (/paymentnotice/on_request) API.

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Sample Postman collection to do these above calls is present in the Appendix Section

Important APIs

Below are the key Business APIs of the HCX Gateway.

API Details
Check Eligibility This API is called by the provider to the payer to check the eligibility of the patient as per the policy.
PreAuth This API is called by the provider to do a pre-authorization of the claim.
Claim This API is called by the provider to the payer to do an actual Claim submission as per the expenses incurred. Ideally, the Claim should be linked with the Preauth and Check Eligibility calls done.
Payment This is a payment notification API which is done by the payer to the provider notifying them that the payment is done.
Status API This API is useful for knowing the Status of the API call.
Registry Search API This API is useful in finding a registered user in HCX.