Candid: Setup and Configuration

Welkin Health offers centralized billing through its integration with Candid Health. This functionality allows organizations to automate the entire RCM and billing process.  To enable the configuration, the following steps are completed by the customer and Welkin teams*: 

Step 1: Contracting

Complete contracting process with Welkin Sales or CSM team

Step 2: Enable Integration

Welkin CSM and integration team will take steps internally to enable the integration

Step 3: Enter Information in the Admin Portal:

1. Enter API Client and API Secret obtained from Candid Health in the Integrations section for the Candid tab
2. Enable and add User Attributes for each user.  The User Attributes are: Billing Zip, Billing Zip4, Billing Address, Billing City, Billing State, Zip, NPI, Self-Pay Billing Organization NPI, Insurance Billing Organization NPI, Billing Tax Code

Step 4: Create Profiles, CDTs, Encounter Dispositions, Billing Form Assessment, and Automation in the Designer Portal:

1. Create an Automation with the Trigger Event Type of “Encounter Finalized” and the Action “Сreate Candid Claim” in order to send data to Candid
   • (A specific Encounter Template can be selected in the Trigger Event if claim information should only be sent to Candid for certain Encounter types.
   • An automation with the Trigger Event of “Encounter Cancelled” with the Action “Сreate Candid Claim” can be created if needed.
2. Create a “Submit to Candid” Encounter Disposition Field
3. • Field Name: Submit to Candid
   • Type: Boolean
   • Display Type: Checkbox
4. Create Profiles, CDTs, and Encounter Disposition fields.  Go to this article to see the fields and their criteria: Fields Needed for Candid Integration
5. Create a Billing Form Assessment if you want a form completed with each Encounter in order to send the claim information to Candid.  Otherwise, the information will be taken directly from the User Attributes, CDTs, and Encounter Disposition fields.

Note: Candid requires the fields sent to it be named in a specific format. It is important that the element names are identical to the field names listed below.

Definitions and Parameters for Information Sent to Candid:

Referring Provider

The final provider who referred the services that were rendered.

Billing Provider

The provider or business entity submitting the claim.

Rendering Provider

The practitioner performing the service, e.g. physician, nurse practitioner, etc..

The Rendering Provider has a few parameters that Welkin sends to Candid.  The information is obtained from the User Attributes in Admin.  They are:  

• First and Last Name
• Billing Tax Code (billingTaxCode)
• NPI If the responisbleParty (Billing Type in Encounter) is SELF_PAY, then the NPI used comes from the selfPayBillingOrganizationNpi User Attribute.  If the responisbleParty is “INSURANCE”, the NPI used is taken from the insuranceBillingOrganizationNpi User Attribute.   If the responsibleParty is not set, then the NPI is taken from the cdt_npi in the Billing Form.  If the NPI is not present in the cdt_npi, then it is taken from the NPI in User Attributes.

Note: Welkin does not send the address to Candid.  Instead, it is housed in Candid.  Due to this, the Automation Audit logs in Admin will show “UNSET” for the data of the address.

The type of services sent to Candid from Welkin depends on the Encounter type.  If the Encounter Delivery Method is CALL or VIDEO, then TELEHEALTH is sent.  If the Encounter Delivery Method is IN PERSON, then OFFICE is sent.

Candid has three fields which will always be sent as “TRUE” from Welkin: benefits_assigned_to_provider, provider_accepts_assignment, and patient_authorized_release which will always be sent as true

Patient information sent to Candid from Welkin is based on the patient type selected in Welkin.

1. If the patient type is ADULT or MINOR, then the patient information from the Patient Profile is sent.
2. If the patient type is COUPLE, then the firstName, lastName, birthDate and gender from the subscriber_primary (insurance info) is sent to Candid.
3. If the insurance cdt is not present, then the information will be taken from the patient profile

Care Portal:

The following Patient Profile fields need to be completed in order to send the claim to Candid:

• First Name

• Last Name

• Gender

• Date of Birth

• Address 1

• State

• City

• Zip code

Before sending the claim to Candid, the “Submit Encounter to Candid” Encounter Disposition field should be completed.

Step 5: Testing

Coordinate testing with your Integration or CSM Manager at Welkin to ensure your workflows are working as desired.

More Questions?
If you have any questions, please email the Customer Success Management team at CSM@welkinhealth.com or contact your Implementation/CSM directly.