CMS’ Shared Systems API

The “Shared Systems” at CMS power the claims processing arm for the agency. As a Provider, this should be interesting to you. There is information around the billing for patients that are covered through Medicare available in these Shared Systems. Requesting that billing information is done through something called “Electronic Data Interchange” (EDI). Here are some common actions:

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• Eligibility and benefits transaction
• Claim submission (837) and emittance (835)
• Claim status transaction

There are also plenty of open source EDI translators out there. Here is one of them: https://bots.readthedocs.io/en/latest/