External Service APIs

An EDI clearinghouse is the central transaction hub for all HIPAA X12 electronic data interchange — claims submission (837), remittance advice (835), eligibility (270/271), referrals and authorizations (278), and enrollment (834). eKlotho Nexus supports direct connection to Availity, Change Healthcare, and Waystar, or any clearinghouse that supports SFTP/AS2 transport with X12 005010 transactions.

The CMS Healthcare Eligibility Transaction System (HETS) provides real-time Medicare Part A, Part B, Part C, and Part D eligibility verification using EDI 270/271 transactions. Required for any organization serving Medicare beneficiaries.

1. Register as CMS Trading PartnerSubmit Trading Partner Agreement (TPA) at https://www.cms.gov/Research-Statistics-Data-and-Systems/CMS-Information-Technology/AccesstoDataApplication
2. Obtain Submitter IDCMS will issue a 10-digit submitter ID and HETS 270 enrollment confirmation.
3. Configure ISA/GS envelopesUpdate ISA06 (your submitter ID) and ISA08 (CMS receiver: CMS) in Admin → EDI Config.
4. Test on CMS HETS Test GatewayCMS provides a test environment. Submit sample 270s and verify 271 responses before production cutover.
5. Enable Real-Time VerificationActivate in Admin → EDI Config → Real-Time Eligibility. eKlotho Nexus will auto-query on patient search.

The National Plan and Provider Enumeration System (NPPES) provides free public access to the NPI Registry — the definitive source for National Provider Identifier lookup, provider demographics, specialty, address, and taxonomy. Used for provider credentialing, claim validation, and network management.

// GET /api/?number=1234567890&version=2.1
{
  "result_count": 1,
  "results": [{
    "number": "1234567890",
    "enumeration_type": "NPI-1",
    "basic": {
      "first_name": "Jane",
      "last_name": "Smith",
      "credential": "MD",
      "sole_proprietor": "NO",
      "enumeration_date": "2010-03-15",
      "status": "A"
    },
    "taxonomies": [{
      "code": "207R00000X",
      "desc": "Internal Medicine",
      "primary": true,
      "state": "CA",
      "license": "A12345"
    }],
    "addresses": [{
      "address_1": "123 Medical Dr",
      "city": "Los Angeles",
      "state": "CA",
      "postal_code": "90001",
      "telephone_number": "310-555-0100"
    }]
  }]
}

Each state's Medicaid agency operates its own MMIS (Medicaid Management Information System) with unique connection requirements. eKlotho Nexus supports X12 EDI, HL7 FHIR, and state-specific proprietary APIs. The following table lists key states and their connection methods.

1. Navigate to Admin → Integrations From the left sidebar, go to Administration → System Admin → Integrations. You'll see all available integration categories with current connection status.
2. Select the integration type Choose the appropriate category: EDI / Clearinghouse, EHR / FHIR, Government APIs, Pharmacy, Labs, or Communication. Each category has a guided setup wizard.
3. Enter credentials and endpoints Provide the service-specific connection parameters: API keys, trading partner IDs, SFTP credentials, or OAuth client credentials. All credentials are encrypted at rest using AES-256.
4. Configure connection parameters Set polling intervals, timeout values, retry policy, and notification recipients for connection failures. Default values are pre-populated based on the service type.
5. Run connectivity test Use the built-in Test Connection button to verify network reachability, authentication, and a sample transaction. A green status indicates readiness.
6. Enable for specific workflows Map the integration to specific modules (e.g., eligibility verification on patient search, NPI lookup in provider add, lab results to patient chart). Unmapped integrations will not auto-trigger.
7. Monitor in Admin → Integrations → Activity Log All integration calls are logged with request/response metadata (no PHI in logs), status codes, and processing times. Set up alerting for error rate thresholds.