n8n-nodes-experian-health

[Velocity BPA Licensing Notice]

This n8n node is licensed under the Business Source License 1.1 (BSL 1.1).

Use of this node by for-profit organizations in production environments requires a commercial license from Velocity BPA.

For licensing information, visit https://velobpa.com/licensing or contact [email protected].

An n8n community node for integrating with Experian Health's healthcare revenue cycle management platform. This node provides access to 6 core resources including eligibility verification, claims management, patient estimates, EDI transactions, provider directory services, and payer connectivity solutions for healthcare organizations.

Features

• Real-time Eligibility Verification - Verify patient insurance coverage and benefits instantly before service delivery
• Comprehensive Claims Management - Submit, track, and manage healthcare claims with automated status monitoring
• Patient Financial Estimates - Generate accurate cost estimates for patients prior to treatment or procedures
• EDI Transaction Processing - Handle X12 EDI transactions including 270/271, 276/277, and 837 claim formats
• Provider Directory Integration - Access and manage healthcare provider network directories and credentialing data
• Payer Connectivity Solutions - Establish secure connections with insurance payers for streamlined data exchange
• Revenue Cycle Optimization - Automate key revenue cycle workflows to reduce denials and improve cash flow
• HIPAA Compliant Operations - Ensure all healthcare data exchanges meet strict privacy and security requirements

Installation

Community Nodes (Recommended)

1. Open n8n
2. Go to Settings → Community Nodes
3. Click Install a community node
4. Enter n8n-nodes-experian-health
5. Click Install

Manual Installation

cd ~/.n8n
npm install n8n-nodes-experian-health

Development Installation

git clone https://github.com/Velocity-BPA/n8n-nodes-experian-health.git
cd n8n-nodes-experian-health
npm install
npm run build
mkdir -p ~/.n8n/custom
ln -s $(pwd) ~/.n8n/custom/n8n-nodes-experian-health
n8n start

Credentials Setup

| Field | Description | Required | |-------|-------------|----------| | API Key | Your Experian Health API authentication key | Yes | | Environment | Production or Sandbox environment | Yes | | Client ID | Your assigned client identifier | Yes |

Resources & Operations

1. Eligibility Verification

| Operation | Description | |-----------|-------------| | Check Eligibility | Verify patient insurance eligibility and benefits | | Get Coverage Details | Retrieve detailed coverage information for a patient | | Verify Benefits | Check specific benefit coverage and limitations | | Real-time Verification | Perform instant eligibility verification |

2. Claims Management

| Operation | Description | |-----------|-------------| | Submit Claim | Submit new healthcare claims for processing | | Check Status | Monitor claim processing status and updates | | Get Claim Details | Retrieve comprehensive claim information | | Update Claim | Modify existing claim data | | Resubmit Claim | Reprocess previously denied or rejected claims | | Get Remittance | Retrieve electronic remittance advice (ERA) |

3. Patient Estimates

| Operation | Description | |-----------|-------------| | Generate Estimate | Create patient cost estimates for procedures | | Get Estimate Details | Retrieve detailed estimate breakdowns | | Update Estimate | Modify existing patient estimates | | Compare Costs | Compare costs across different providers | | Verify Insurance Impact | Calculate patient responsibility after insurance |

4. EDI Transactions

| Operation | Description | |-----------|-------------| | Send EDI 270 | Submit eligibility inquiry transactions | | Receive EDI 271 | Process eligibility response transactions | | Send EDI 276 | Submit claim status inquiry transactions | | Receive EDI 277 | Process claim status response transactions | | Send EDI 837 | Submit healthcare claim transactions | | Validate Transaction | Verify EDI transaction format and content |

5. Provider Directory

| Operation | Description | |-----------|-------------| | Search Providers | Find healthcare providers by criteria | | Get Provider Details | Retrieve comprehensive provider information | | Verify Credentials | Check provider credentialing status | | Update Provider Info | Modify provider directory data | | Check Network Status | Verify provider network participation |

6. Payer Connectivity

| Operation | Description | |-----------|-------------| | Establish Connection | Create secure payer connections | | Test Connectivity | Verify payer system availability | | Get Payer List | Retrieve supported payer organizations | | Monitor Status | Check payer connection health | | Configure Settings | Manage payer-specific connection parameters |

Usage Examples

// Check patient eligibility before appointment
{
  "patientId": "PAT123456",
  "memberId": "ABC123456789",
  "payerId": "AETNA",
  "serviceDate": "2024-01-15",
  "providerNPI": "1234567890"
}

// Submit a professional claim
{
  "claimId": "CLM20240115001",
  "patientId": "PAT123456",
  "providerId": "PROV001",
  "serviceLines": [
    {
      "procedureCode": "99213",
      "diagnosisCode": "Z00.00",
      "chargeAmount": 150.00,
      "serviceDate": "2024-01-15"
    }
  ]
}

// Generate patient estimate for procedure
{
  "patientId": "PAT123456",
  "procedureCode": "29881",
  "facilityId": "FAC001",
  "estimateType": "comprehensive",
  "includeInsurance": true
}

// Send EDI 270 eligibility inquiry
{
  "transactionType": "270",
  "memberId": "XYZ987654321",
  "payerId": "BCBS",
  "providerNPI": "9876543210",
  "serviceTypeCodes": ["30", "35", "86"]
}

Error Handling

| Error | Description | Solution | |-------|-------------|----------| | Invalid API Key | Authentication credentials are incorrect | Verify API key and client ID in credentials | | Patient Not Found | Specified patient ID does not exist | Check patient identifier and ensure proper registration | | Payer Unavailable | Insurance payer system is temporarily down | Retry request or check payer connectivity status | | Invalid EDI Format | EDI transaction contains formatting errors | Validate transaction structure against X12 standards | | Eligibility Expired | Patient insurance eligibility has expired | Verify current coverage dates and update patient information | | Claim Rejected | Submitted claim was rejected by payer | Review rejection reason and correct claim data before resubmission |

Development

npm install
npm run build
npm test
npm run lint
npm run dev

Author

Velocity BPA

• Website: velobpa.com
• GitHub: Velocity-BPA

Licensing

This n8n community node is licensed under the Business Source License 1.1.

Free Use

Permitted for personal, educational, research, and internal business use.

Commercial Use

Use of this node within any SaaS, PaaS, hosted platform, managed service, or paid automation offering requires a commercial license.

For licensing inquiries: [email protected]

See LICENSE, COMMERCIAL_LICENSE.md, and LICENSING_FAQ.md for details.

Contributing

Contributions are welcome! Please ensure:

1. Code follows existing style conventions
2. All tests pass (npm test)
3. Linting passes (npm run lint)
4. Documentation is updated for new features
5. Commit messages are descriptive

Support

• Issues: GitHub Issues
• Experian Health API Documentation: Developer Portal
• Healthcare EDI Standards: X12 Implementation Guides