Understanding the Redox Claims Data Model

Does this mean Redox can integrate with Practice Management Systems as well as EHRs?

We can support integrations with practice management systems as well as other revenue cycle specific products. If we have not already integrated with a specific system that you’re interested in, we’re happy to speak with the vendor and identify their integration capabilities and how we could support a connection with them via Redox.

Does this mean Redox can integrate with insurance companies or clearinghouses?

We can certainly integrate with insurance companies and clearinghouses, but these are not native integrations that we could immediately activate for you. We would require that you have a contract/business associates agreement in place with the organization that allows you to connect and integrate with them.

Are claims messages sent in real time?

Technically claims integrations could be real-time, but in practice most organizations will run an overnight or end of day batch job to trigger messages. In these scenarios, we will still receive the messages and send them downstream to you in real time, but typically health care organizations are not sending ad hoc claims messages throughout the day.

Do you support applying business logic to claims integrations?

While we do support filtering within our API to reduce unwanted messages (e.g. only pass along messages from a specific department or messages with specific charge codes), we do not currently support applying comprehensive business logic or rules to our integrations.