API Connectivity Guide
Complete reference for all API integrations required by the eKlotho Nexus platform, organized by standard (EDI X12, HL7 FHIR, REST) and by function. This guide provides the integration requirements, endpoints, and guidelines for connecting eKlotho Nexus with external systems.
109
Total API Endpoints
12
EDI Transaction Types
15+
FHIR Resources
8
Org Types Supported
EDI X12 Transaction Standards
| Transaction | Code | Purpose | Used By |
|---|---|---|---|
| Eligibility Inquiry/Response | 270/271 | Real-time member eligibility verification | All org types |
| Claim Submission | 837 P/I/D | Professional, Institutional, Dental claims | MCOs, TPAs, IPAs, Health Plans |
| Remittance Advice | 835 | Payment and adjustment details | All claims processors |
| Claim Status | 276/277 | Claim processing status inquiry | All org types |
| Prior Authorization | 278 | Health care services review request/response | MCOs, IPAs, TPAs, Health Plans |
| Enrollment | 834 | Benefit enrollment and maintenance | MCOs, TPAs, Health Plans |
| Premium Payment | 820 | Premium payment and remittance | TPAs, Health Plans |
HL7 FHIR APIs
eKlotho Nexus implements FHIR R4 APIs compliant with CMS Interoperability and Patient Access Final Rule requirements.
| API | FHIR Resources | Purpose | Regulation |
|---|---|---|---|
| Patient Access | Patient, Coverage, ExplanationOfBenefit, Condition, Observation | Member health data access | CMS-9115-F |
| Provider Directory | Practitioner, PractitionerRole, Organization, Location, HealthcareService | Machine-readable provider directory | CMS-9115-F |
| Payer-to-Payer | Patient, Coverage, Clinical data | Payer data exchange at member request | CMS-0057-F |
| Prior Authorization | Claim, ClaimResponse, Coverage | Electronic prior auth (Da Vinci PAS) | CMS-0057-F |
| Drug Formulary | MedicationKnowledge, InsurancePlan | Formulary data access | CMS-9115-F |
| Bulk Data Export | All clinical resources | Population-level data export | ONC HTI-1 |
| Care Plan | CarePlan, Goal, ServiceRequest | Care plan data exchange | US Core IG |
| ADT Notifications | Encounter, Patient | Admission/Discharge/Transfer alerts | Da Vinci Alerts |
External System Integrations
Credentialing & Provider Data
CAQH ProView API— Provider credentialing dataNPPES NPI Registry— National Provider Identifier lookupCMS PECOS— Medicare provider enrollment verificationState Licensing Boards— License verification by stateDEA NTIS— DEA registration verificationOIG/SAM Exclusion Lists— Sanctions screening
Pharmacy & Medication
NCPDP Transactions— Pharmacy claims processingReal-Time Benefit Check (RTBC)— Formulary/cost at point of prescribingHRSA 340B OPAIS— 340B program administrationFirst Databank / Medi-Span— Drug interaction databasese-Prescribing (NCPDP SCRIPT)— Electronic prescribingState PDMP— Prescription Drug Monitoring Programs
CMS & Government
CMS HPMS— Health Plan Management SystemCMS MARx— Medicare Advantage enrollmentCMS RAPS/EDPS— Risk adjustment data submissionHRSA EHB— Electronic Handbooks for FQHCsState Medicaid Portals— State-specific Medicaid interfacesIRS ACA Reporting— 1094-C / 1095-C filing
Quality & Reporting
HEDIS Measure Engine— Quality measure calculationQRDA I/III— Quality reporting documentsCAHPS Survey Vendors— Member satisfaction surveysState Immunization Registries— Immunization reportingHIE/Carequality/CommonWell— Health information exchangeUDS Reporting— FQHC uniform data system
API Requirements by Organization Type
| API Category | IPA | PHO | ACO | MSO | TPA | MCO | FQHC | Health Plan |
|---|---|---|---|---|---|---|---|---|
| EDI Claims (837/835) | Req | Req | Opt | Req | Req | Req | Opt | Req |
| Eligibility (270/271) | Req | Req | Req | Opt | Req | Req | Req | Req |
| Prior Auth (278) | Req | Req | Req | N/A | Req | Req | Opt | Req |
| FHIR Patient Access | Opt | Opt | Req | N/A | Opt | Req | Req | Req |
| HEDIS/Quality | Req | Req | Req | N/A | N/A | Req | Req | Req |
| Risk Adjustment (HCC) | Req | Opt | Req | N/A | N/A | Req | N/A | Req |
| Enrollment (834) | Opt | Opt | Opt | Opt | Req | Req | Req | Req |
| CAQH Credentialing | Req | Req | Opt | Req | Opt | Req | Opt | Req |
Req = Required Opt = Optional N/A = Not Applicable
Complete API Inventory
| API Endpoint | Module |
|---|---|
ADT notification API (HL7/FHIR) |
Care Coordination |
Accumulator inquiry API |
Products & Benefits |
Activity log API |
Patient Management |
Alert acknowledgment API |
Alerts & Notifications |
Alert notification API |
Vitals & Remote Patient Monitoring |
Alert subscription API |
Alerts & Notifications |
Audit export API |
Compliance |
Audit log export API |
Administration |
Authorization status inquiry API |
Prior Authorization |
Benefit configuration API |
Products & Benefits |
CAQH ProView API |
Provider Network Management |
CMS HPMS API |
Regulatory Management |
CMS HPMS submission API |
Products & Benefits |
CMS Stars API |
Analytics & Reporting |
CMS Stars data API |
Population Health |
COBRA administration API |
Employer Groups |
Calendar sync API (CalDAV/iCal) |
Appointments & Scheduling |
Campaign analytics API |
Communication & Outreach |
Capitation calculation API |
Risk Pools & Shared Savings |
Care plan FHIR API |
Care Coordination |
Case management API |
Grievances & Appeals |
Census import API |
Employer Groups |
Claims search and inquiry API |
Claims Management |
Clinical assessment API |
Clinical Tools |
Clinical criteria lookup API |
Prior Authorization |
Clinical guideline API |
Care Coordination |
Compliance dashboard API |
Compliance |
Compliance tracking API |
Regulatory Management |
Configuration API per tenant |
Multi-Tenant Management |
Corrective action API |
Compliance |
Cross-client analytics API |
Multi-Tenant Management |
Custom report API (REST) |
Analytics & Reporting |
Da Vinci Prior Auth FHIR API |
Prior Authorization |
Device data ingestion API (FHIR Observation) |
Vitals & Remote Patient Monitoring |
Document search API |
Document Management |
Document upload/download API |
Document Management |
Drug interaction check API |
Medication Management |
EDI configuration API (X12 partner management) |
Administration |
Eligibility inquiry API (FHIR Coverage) |
Enrollment & Eligibility |
Email delivery API |
Communication & Outreach |
FHIR Bulk Data Export API |
Analytics & Reporting |
FHIR CarePlan/Questionnaire APIs |
Clinical Tools |
FHIR Clinical Data APIs (Condition, Observation, etc.) |
Patient Management |
FHIR Patient Access API |
Patient Management |
FHIR PractitionerRole/Organization |
Provider Network Management |
FHIR SDOH APIs (Gravity Project) |
Population Health |
Filing status API |
Regulatory Management |
Financial reporting API |
Financial Management |
Formulary API (FHIR MedicationKnowledge) |
Medication Management |
Fraud alert notification API |
Claims Management |
General ledger sync API |
Financial Management |
Grant management API |
FQHC Management |
Grievance intake API |
Grievances & Appeals |
Group billing API |
Employer Groups |
HEDIS data submission API |
Analytics & Reporting |
HEDIS data submission API |
Population Health |
HRSA 340B OPAIS API |
FQHC Management |
LDAP/SAML/OIDC integration for SSO |
Administration |
Letter generation API |
Grievances & Appeals |
Member portal API |
Enrollment & Eligibility |
Member search API |
Enrollment & Eligibility |
NCPDP pharmacy transactions |
Medication Management |
NPPES NPI Lookup API |
Provider Network Management |
Notification delivery API (push/SMS/email) |
Alerts & Notifications |
OCR processing API |
Document Management |
Open enrollment portal API |
Employer Groups |
PPS rate lookup API |
FQHC Management |
Patient search API |
Patient Management |
Payer profile API |
Billing & Insurance |
Payment processing API (ACH/EFT) |
Financial Management |
Plan comparison API |
Products & Benefits |
Predictive model scoring API |
Population Health |
Provider directory API (CMS machine-readable) |
Provider Network Management |
Provider portal API |
Provider Network Management |
Provider portal submission API |
Prior Authorization |
RPM program enrollment API |
Vitals & Remote Patient Monitoring |
Rate table management API |
Financial Management |
Real-time benefit check (RTBC) API |
Medication Management |
Regulatory calendar API |
Regulatory Management |
Regulatory reporting API |
Grievances & Appeals |
Retention management API |
Document Management |
Revenue cycle dashboard API |
Billing & Insurance |
Risk adjustment API (HCC) |
Population Health |
Risk pool configuration API |
Risk Pools & Shared Savings |
Risk score calculation API |
Care Coordination |
SMS gateway API (Twilio/equivalent) |
Communication & Outreach |
Scheduled report webhook |
Analytics & Reporting |
Scheduling API (FHIR Appointment/Schedule) |
Appointments & Scheduling |
Screening protocol API |
Clinical Tools |
Secure messaging API |
Care Coordination |
Secure messaging API |
Patient Management |
Settlement processing API |
Risk Pools & Shared Savings |
Shared savings API |
Risk Pools & Shared Savings |
Sliding fee calculation API |
FQHC Management |
Telehealth session API |
Appointments & Scheduling |
Template management API |
Communication & Outreach |
Tenant management API |
Multi-Tenant Management |
UDS submission API |
FQHC Management |
Usage metering API |
Multi-Tenant Management |
User management API (SCIM 2.0) |
Administration |
X12 270/271 Eligibility API |
Billing & Insurance |
X12 270/271 Eligibility Verification |
Enrollment & Eligibility |
X12 276/277 Claim Status |
Claims Management |
X12 278 Request/Response (EDI) |
Prior Authorization |
X12 820 Premium Payment |
Financial Management |
X12 834 Enrollment Processing |
Enrollment & Eligibility |
X12 834 Group Enrollment |
Employer Groups |
X12 835 Remittance Advice |
Claims Management |
X12 837 Claim Submission (P/I/D) |
Claims Management |