PAYERS & REIMBURSEMENT CONNECTORS

Best Practices / APIs & SDK / Production Onboarding

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Integrate payer eligibility, claims, reimbursement and reconciliation workflows without turning Mediloop into a payer or payment institution.

Architecture SummaryBest PracticesAPIs & SDKSandboxCertificationComplianceProduction Onboarding

Production Ready Integrations

Use reliable, secure patterns and reconciliation.

Standards Based

Build on FHIR/open standards with payer-specific adapters.

Multiple Payer Ecosystems

Support national and complementary payer variation.

From Sandbox to Go-Live

Use structured testing, compliance and onboarding.

Architecture Summary

Care Workflows

Services, pharmacy, hospital and billing contexts

Payer Orchestration

Eligibility, authorization, claims and status

Payer Adapters

CNS, CPAM and complementary insurers

Payer Decision

Authoritative adjudication

Monitoring & Reconciliation

Exceptions, settlement status and audit

Best Practices

Never hard-code payer logic in product UI

Keep national/payer adapters isolated behind stable Mediloop contracts

Use idempotency and correlation IDs for all submissions

Preserve original payer codes/responses and rule versions

Separate estimate, adjudication and settlement concepts

Build manual exception handling for non-deterministic payer cases

Do not hold/settle funds through Mediloop

APIs & SDK

typescriptCopy

// Illustrative SDK surface
const eligibility = await client.payers.checkEligibility({
  payer: 'cns-lu',
  patientId: 'patient_123',
  serviceCode: 'CONSULT',
});

const claim = await client.payers.submitClaim({ /* validated claim */ });

SDK and route names are illustrative until published; payer adapters may expose different required fields while the Mediloop contract remains versioned.

Sandbox & Testing

Synthetic/approved payer test patients and coverages

Positive/negative eligibility cases

Authorization required/not-required cases

Claim validation and payer rejection scenarios

Timeout/retry/idempotency tests

Partial reimbursement and reconciliation cases

Certificate/credential rotation tests

Certification & Compliance

Complete payer/national onboarding agreements

Meet national security/conformance requirements

Validate required FHIR/national profiles

Review GDPR and data minimization

Document operational responsibilities and incident contacts

Capture approval evidence

Production Onboarding

Plan

Payers, use cases, owners and contracts

Validate

Sandbox and conformance

Approve

Security/compliance/certification

Deploy

Production config and rollout

Operate

Monitor, reconcile and improve

Developer Integration Surface

Surface	Operation / resource	Use	Status
Payer API	eligibility / auth / claims / status	Stable app integration	Versioned when frozen
FHIR	Coverage / Claim / ClaimResponse / EOB	Healthcare financial resources	FHIR where applicable
Payer adapters	national/private APIs / EDI / files	External payer connectivity	Payer-specific
SDK	Typed workflow helpers	Developer productivity	Published versions only
Events	status / exceptions / reconciliation	Async workflow	Planned/evolving

Next Steps

Select first payer/use case

Complete onboarding prerequisites

Implement/test against sandbox

Pass security/conformance review

Deploy gradually with monitoring

Reconcile and audit from day one