Source-Based Documentation

NEXUS EDI app capabilities from the backend source code

This reference summarizes the production app features represented in the backend source, including claims, eligibility, ERA, medical records attachments, AI billing tools, reporting, security, API automation, and Arizona medical billing workflows.

Documentation note: this page is linked from the site documentation, listed in the sitemap, and summarized in llms.txt so search engines and AI crawlers can understand the real NEXUS EDI application capabilities.

Backend Architecture

Application Core

The backend is an Express and TypeScript API mounted at /api/v1. It includes request logging, JSON parsing, compression, global error handling, health checks, and version/status endpoints.

Security Baseline

The server uses Helmet, credentialed CORS, rate limiting, authenticated route guards, role and permission checks, active-session checks, tenant context, and subscription enforcement on protected workflows.

Tenant Isolation

Authenticated requests attach user, role, permission, and tenant context. The backend sets row-level security context variables so tenant-scoped data can be isolated across the application.

Automation Surface

The app exposes API key management, webhook workflows, cache and metrics routes, notifications, usage alerts, scheduled jobs, Stripe billing, and Socket.IO support for live operational updates.

Capability Map

Area Implemented Source Surface Customer-Safe Message
Claims Claim CRUD, filtering, search, stats, validation, duplication, batch create, batch submit, submission, audit/history, appeals, status tracking, and attachments. NEXUS EDI manages the claim lifecycle from draft through validation, submission, status follow-up, attachment handling, and denial response.
Medical Records Attachments Claim attachment upload, list, download, and delete routes with permission checks. The platform supports electronic claim attachments, including medical records workflows tied directly to claims.
Batch Upload Batch upload accepts CSV, JSON, XML, XLS, XLSX, 837, X12, and EDI files for claims, eligibility, ERA, and attachments, with status and record-level review. Teams can process high-volume billing files and track validation progress before submitting valid records.
Eligibility Patient eligibility checks, ClaimsMD eligibility checks, eligibility history, and batch eligibility checks. Billing teams can verify patient eligibility before submission and review eligibility history from one workflow.
Clearinghouse ClaimsMD and clearinghouse routes for claim submission, status checks, batch status, acknowledgments, remittances, and provider enrollment workflows. NEXUS EDI connects claim submission, status retrieval, payer acknowledgments, and enrollment operations in one platform.
ERA and Remittance ERA list, stats, fetch, sync, missing-detail fetch, post all, post individual ERA, details, mark processed, download, and delete. The app supports ERA retrieval, analysis, posting, export, and remittance workflow visibility.
AI Assistance Code suggestions, claim review, rejection explanations, fraud detection, outcome prediction, appeal letters, batch denial analysis, history, and stats. AI assists billers with claim review, coding support, rejection explanations, denial analysis, appeal drafting, and risk visibility.
Reports Claims analytics, enhanced claims reports, denial trends, provider performance, revenue analytics, executive reporting, custom reports, exports, scheduled reports, delivery history, and downloads. Leadership and billing teams can monitor revenue cycle performance, denials, provider productivity, and scheduled reporting.
Billing and Subscription Stripe webhooks, plans, subscription create/update/cancel, payment methods, invoices, usage, claim-limit checks, upgrades, tiers, and add-ons. The platform includes subscription controls, billing usage, payment methods, invoices, and plan-limit enforcement.
Admin Operations Tenant, user, session, audit, notification, cache, metrics, provider, payer, patient, diagnosis code, and procedure code routes. Admins can manage users, tenants, operational data, audit visibility, payer/provider records, and platform monitoring.

Security and Compliance Notes

Authentication

  • JWT bearer authentication validates user status and session status.
  • Inactive, expired, or timed-out sessions are blocked.
  • Two-factor routes include TOTP and email-based flows.

Authorization

  • Routes use role and permission middleware such as view_claims, submit_claims, view_reports, and manage_eras.
  • Super Admin-only flows are isolated for tenant and platform administration.
  • API keys can be created, listed, revoked, deleted, and reported through stats.

Subscription Enforcement

  • Authenticated routes check tenant status and subscription health.
  • Billable workflows can require an active subscription before execution.
  • Usage and limit checks support claim-volume controls.

Audit Readiness

  • Audit services and audit routes support activity visibility.
  • Claim history, status tracking, ERA posting, and report delivery history provide workflow traceability.
  • Cache and metrics routes support operational monitoring.

Public FAQ Content Seeds

Medical Records Attachments

NEXUS EDI supports claim-level attachment workflows, including upload, review, download, and deletion. Public copy can safely describe this as electronic medical records attachment support for claim documentation.

NEMT Billing

The claim, payer, eligibility, attachment, batch submission, ERA, and reporting capabilities are relevant to NEMT providers that need a unified billing workflow for Arizona Medicaid-related operations.

AI Claim Review

The AI route set supports code suggestions, claim review, rejection explanations, fraud detection, outcome prediction, appeal letter drafting, and batch denial analysis.

Operational Visibility

Reports, scheduled reports, ERA stats, claim stats, audit logs, notifications, usage alerts, cache, and metrics provide evidence for visibility claims in SEO and AEO content.