Integration Workflows and Overview

The Kipu CRM, EMR, and RCM integrations work together to eliminate duplicate data entry, reduce manual errors, and streamline admissions, billing, and payer management across your organization.

• Kipu CRM supports prospect management and automates downstream record creation.
• Kipu EMR manages patient demographics, clinical documentation, and charges.
• Kipu RCM serves as the single source of truth for insurance, eligibility, utilization review (U/R), and billing.

Because prospect and patient records are shared across systems—and payer management occurs exclusively in the RCM—eligibility, insurance, and billing workflows are simplified and more efficient.

CRM + EMR + RCM Integration Overview

EMR + RCM Integration Overview

End-to-End Integration Workflow

The following sections outline the high-level workflow from prospect creation (if using CRM) through claim submission. Each step represents a key handoff between systems and links to more detailed instructions where applicable.

Step 1: Prospect Creation (CRM/EMR)

Organizations using Kipu CRM begin the admissions process by creating and managing prospects before admission. Note that this same process applies to creating pre-admitted patients in the EMR.

1. Create a Prospect in the CRM
   A prospect record is created in the CRM. Click here for instructions on how to make a prospect in the CRM.
2. Automatic RCM Record Creation
   The prospect is automatically created in the RCM as a patient with as a Prospective Patient.
3. Add Insurance and Treatment Opportunity
   Add insurance information to the prospect record and create a Treatment Opportunity.
4. Push to EMR for Admission
   When the prospect is ready to admit, push the Treatment Opportunity to the EMR.

Step 2: Patient Admission (EMR → RCM)

These steps apply whether the patient originated in the CRM or was created directly in the EMR.

1. Accept and Complete the Patient Record (EMR)
   • Accept the incoming patient record (if pushed from CRM)
   • Add an Admission Date and MR Number
   • Complete all required demographic fields
   • Add at least one diagnosis code
2. Send the Patient to RCM
   Automatically generating the MR Number sends the patient to the RCM. Updates can also be sent manually by clicking Send to Kipu RCM from the Facesheet. For more information on creating patients using the EMR + RCM integrations, click here.
3. RCM Treatment Episode Creation
   The patient record is created or updated in the RCM, the patient's profile is updated to Admitted, and a treatment episode is created in the RCM.

Step 3: Insurance & Eligibility

1. Insurance Entry
   • Add or review insurance information in the EMR by clicking Manage Insurance.
   • Complete the Insurance Set in the RCM, including primary, secondary, and tertiary payers as needed.
   • Verify payer and policyholder details.
2. Eligibility Verification
   • Initiate an electronic eligibility check from the iframe in the EMR.
   • Review and complete eligibility results in the RCM. Click here for more information on verifying eligibility in the RCM.

Step 4: Utilization Review (U/R)

1. Add a U/R Plan (EMR)
   From the patient Facesheet, select Manage Review to add a utilization review plan.
2. Complete U/R Details (RCM)
   Finalize utilization review details in the RCM. 

Step 5: Charges, Billing, & Claims

1. Document Services (EMR)
   Record billable services through Group Sessions or Evaluations.
2. Transmit Charges (EMR)
   Review billed items and transmit selected charges using the Billing Audit Tool Report.
3. Review and Submit for Billing (RCM)
   Review services in the Attendance Calendar and submit selected treatments for billing. Click here for more information on the Attendance Calendar.
4. Create and Submit Claims (RCM)
   Complete claim creation and submission in the Work Center.

EMR + RCM Data Integration Tables

The following tables contain information on the Kipu EMR + Kipu RCM-integrated fields, including the source of truth for each field.

• Patient information is transferred to the RCM in two distinct ways.

  1. The first is when the initial connection is established. This is the first time the patient is sent from the EMR to the RCM, creating the admitted patient record in the RCM. This connection can be established by: creating the MR Number, clicking Manage Insurance, clicking Manage Review, or clicking Sent to Kipu RCM.
  2. The second is when some fundamental demographic information has been changed. The patient demographic details will be resent to the Kipu RCM when a new Diagnosis Code is added, when a Discharge/Transition Date is added, or when a user clicks Sent to Kipu RCM. 

  Patient Information is one-directional (from EMR to RCM), so the EMR will be the source of truth for patient demographic information. Any updates needed should be made in the EMR and sent to RCM.

  EMR Field	RCM Location/Field	When is the info sent to the RCM?	Source of Truth
  Patient ID	Patient > Profile > Patient ID	Upon establishing the initial connection or by clicking the Sent to Kipu RCM button.	EMR
  MR Number	Patient > Treatment Episode > Intake > Patient Profile > Medical Record Number	Upon establishing the initial connection or by clicking the Sent to Kipu RCM button.	EMR
  Last Name, First, Middle Name	Patient > Profile > Last Name, First Name, Middle Initial	Upon establishing the initial connection or by clicking the Sent to Kipu RCM button.	EMR
  Date of Birth	Patient > Profile > Birthday	Upon establishing the initial connection or by clicking the Sent to Kipu RCM button.	EMR
  Birth Sex	Patient > Treatment Episode > Intake > Insurance > Insurance Set > Policy Holder > Gender	Upon establishing the initial connection or by clicking the Sent to Kipu RCM button.	EMR
  Address, City, State, Zip	Patient > Treatment Episode > Intake > Patient Profile > Address, City, State, Zip Code	Upon establishing the initial connection or by clicking the Sent to Kipu RCM button.	EMR
  Phone	Patient > Profile > Phone	Upon establishing the initial connection or by clicking the Sent to Kipu RCM button.	EMR
  SSN	Patient > Profile > Social Security Number	Upon establishing the initial connection or by clicking the Sent to Kipu RCM button.	EMR
  Admission Date	Patient > Treatment Episode > Intake > Admit/Discharge > Admit Date and Admit Time	Upon establishing the initial connection or by clicking the Sent to Kipu RCM button.	EMR
  Discharge/ Transition Date	Patient > Treatment Episode > Intake > Admit/Discharge > Discharge Date and Discharge Time	Automatically, once the field is populated in the EMR.	EMR
  Diagnosis	Patient > Treatment Episode > Intake > Behavioral/Standalone Diagnoses > Admitting Diagnosis & Principal Diagnosis Note: However if more than 18 diagnosis codes are present, only the first 18 will be transmitted. Additionally, HL7 transmissions for DG1 segments will treat the date the diagnosis code was added as the start date using the manage diagnosis codes evaluation workflow.	Automatically, once the field is populated in the EMR.	EMR

• Insurance information is added directly into the RCM from a pop-up window in the EMR by clicking the Manage Insurance button on the patient facesheet. The integration for insurance information flows from the RCM to the EMR, so the RCM is the source of truth for insurance information. 

  EMR Location/Field	RCM Location/Field	When is the info sent to EMR?	Source of Truth
  Insurance Information > Company	Patient > Treatment Episode > Intake > Insurance > Payer	When updates are saved in the RCM.	RCM
  Insurance Information > Policy No.	Patient > Treatment Episode > Intake > Insurance > Insurance Set > Policy Holder > Insurance ID	When updates are saved in the RCM.	RCM
  Insurance Information > Plan Name	Patient > Treatment Episode > Intake > Insurance > Insurance Set > Policy Holder > Plan Name	When updates are saved in the RCM.	RCM
  Insurance Information > Effective Date	Patient > Treatment Episode > Intake > Insurance > Effective Date	When updates are saved in the RCM.	RCM
  Insurance Information > Insurance Priority	Patient > Treatment Episode > Intake > Insurance > Primary, Secondary, or Tertiary	When updates are saved in the RCM.	RCM
  Insurance Information > Phone	Patient > Treatment Episode > Intake > Insurance > Insurance Set > Payer > Payer Phone	When updates are saved in the RCM.	RCM
  Insurance Information > Subscriber	Patient > Treatment Episode > Intake > Insurance > Insurance Set > Policy Holder > (Subscriber) First Name & (Subscriber) Last Name	When updates are saved in the RCM.	RCM
  Insurance Information > Relationship	Patient > Treatment Episode > Intake > Insurance > Insurance Set > Policy Holder > Patient Relationship to Insured	When updates are saved in the RCM.	RCM
  Insurance Information > SSN (Subscriber) Auto-populated for Self	N/A if not Self	After clicking the Sent to Kipu RCM button.	EMR
  Insurance Information > DOB (Subscriber)	Patient > Treatment Episode > Intake > Insurance > Insurance Set > Policy Holder > (Subscriber) Birthday	When updates are saved in the RCM.	RCM
  Insurance Information > Gender (Subscriber)	Patient > Treatment Episode > Intake > Insurance > Insurance Set > Policy Holder > (Subscriber) Gender	When updates are saved in the RCM.	RCM
  Insurance Information > Subscriber Address Street, City, Zip, State Auto-populated for Self	N/A if not Self	After clicking the Sent to Kipu RCM button.	EMR

• Authorizations are added directly into the RCM from a pop-up window in the EMR by clicking the Manage Review button on the patient's face sheet. The integration for Authorization information flows from the RCM to the EMR, so the RCM is the source of truth for authorization information. 

  EMR Location/Field	RCM Location/Field	When is the info sent to EMR?	Source of Truth
  Patient > Information tab > Utilization Reviews > Start Date	Patient > Treatment Episode > Scheduling and Utilization > U/R > Start Date	When updates are saved in the RCM.	RCM
  Utilization Reviews > End Date	Patient > Treatment Episode > Scheduling and Utilization > U/R > End Date	When updates are saved in RCM.	RCM
  Utilization Reviews > # of Days	Patient > Treatment Episode > Scheduling and Utilization > U/R > Units	When updates are saved in RCM.	RCM
  Utilization Reviews > Auth date (auto-populated with Start Date)	Patient > Treatment Episode > Scheduling and Utilization > U/R > Start Date	When updates are saved in RCM.	RCM
  Utilization Reviews > Authorization #	Patient > Treatment Episode > Scheduling and Utilization > U/R > Authorization Number	When updates are saved in RCM.	RCM
  Utilization Reviews > Status	Patient > Treatment Episode > Scheduling and Utilization > U/R > Authorization Status Authorized and Authorized - Not Required statuses will appear as Approved in the EMR.	When updates are saved in RCM.	RCM
  Utilization Reviews > Managed	Will be set to:  Managed for authorization status of authorized, denied, pending, or required - not obtained Nonmanaged for authorization status of Not Required	N/A	EMR
  Utilization Reviews > Level of Care	Patient > Treatment Episode > Scheduling and Utilization > U/R > Service	When updates are saved in RCM.	RCM
  Utilization Reviews > Next review	Patient > Treatment Episode > Scheduling and Utilization > U/R > UM Follow-Up Date	When updates are saved in RCM.	RCM
  Utilization Reviews > Days of week (auto-populated from EMR Level of Care configuration)	N/A	N/A	EMR
  Utilization Reviews > Insurance	Patient > Treatment Episode > Scheduling and Utilization > U/R > Payer	When updates are saved in RCM.	RCM

• The majority of charge data that appears on the Billing Audit Tool Report is not transferred to the RCM. This information is instead used to match the charges between the two systems. This allows the RCM to apply billing service profiles and claim rules more accurately, simplifying claim submission.

  Because no demographic data is transferred with the billing audit tool report transmission, you must have transmitted the patient's complete profile to the RCM and added in the patient's insurance and authorization information (if required) before submitting charges to the RCM from the report. 

  Data on the Billing Audit Tool Report	Transmitted to RCM?	Function
  Date of Service	Yes	Appears on the Attendance Calendar
  Admit Date	No	Used to match the patient's treatment episode between EMR and the RCM
  Location	No	Used to match the patient's treatment episode between EMR and the RCM
  Insurance	No	Used to match the patient's treatment episode between EMR and the RCM
  Level of Care	No	Used to match to the Level of Care configured in the RCMwith a unique ID for that LOC shared between the two systems. Unlike ancillary codes, LOC can match based on the unique ID instead of service name. However, if the system cannot match based on the unique ID, the default code-matching process will occur. This means that the systems will look at the Service Description in the EMR and match that to the Service Name in the RCM so the best practice is to have them match exactly. If an exact match is not found, the system will attempt to match based on Revenue Code, Procedure Code, Modifier, and Claim Format (Institutional/Professional).
  Codes	No	Codes are matched to the the RCM Service using the Service Description in the EMR and match that to the Service Name in RCM so the best practice is to have them match exactly. If an exact match is not found, the system will attempt to match based on Revenue Code, Procedure Code, Modifier, and Claim Format (Institutional/Professional). Additionally, the RCM will first look at insurance pay codes before attempting to match Private Pay codes.
  Modifiers	No	Modifiers are not imported and are used as part of the charge-matching process. They are typically built directly into the code's profile and will be ignored if sent from the billing audit tool report if they don't match a particular service in the RCM. The best practice is to add the modifier in the RCM using a claim rule or directly on the service if needed.
  Units	Yes	Every service comes into the RCM with a single unit (1) associated with it. If you transfer over multiple of the same services in a day (uncommon) each will have a single unit attached (e.g., 3 charges for OP Group Sessions transmitted will result in 3 units).
  Claim Format	No	This is part of the charge matching logic and can help identify the claim format in the RCM but this field is not used to determine whether the claim will be billed as Institutional or Professional. This is determined within the RCM.
  Rendering Provider	Yes	The Rendering Provider configured in the Konnector will be the Rendering Provider sent on most claims. Any charge with a blank Rendering Provider field on the billing audit tool report will automatically use the Konnector Rendering Provider. To bill a different provider as the Rendering Provider, they must be configured as the Rendering Provider on the Authorization (or Standalone Authorization for Ancillary Services) and selected on the report to transmit to the RCM. This is true for both Level of Care and Ancillary services. If the provider is not present in both places, the charge will not transmit.
  Diagnosis Codes	No	These are included in the Patient Demographics and are only used to match charges. For Ancillary services, if you need to add an additional diagnosis code, please make the update on the patient record in the EMR and re-transmit the patient to the RCM before sending the charges from the billing audit tool report if you want those diagnosis codes to appear on the claim for that charge.
  Place of Service	No	This field is used to map the charge to the correct service profile in the RCM as described in the Codes section.
  Duration Met/Required Duration	No	This field is not mapped as all services come into the RCM with a single unit. Even if the required duration was not met and the charge was sent to the RCM, the service will be mapped with a single unit.
  Program	No	Used to match the patient's treatment episode between EMR and the RCM.

Process Documents

The following process documents describe how to leverage the Kipu EMR + RCM to build patient records, add utilization plans, document billables, and send these charges to the RCM for billing.

• Create Patients: This article goes over how to create a pre-admitted patient and an admitted patient using the EMR + RCM integration. This article also details common issues and their resolutions when transmitting the patient demographics to the RCM.
• Add Insurance: Review how to add primary, secondary, and tertiary insurance plans with the integration.
• Add Utilization Plans: Learn how to a U/R Plan to the patient's concurrent reviews for Level of Care/per-diem billing.
• Add Standalone Authorizations: Learn how to add a standalone authorization for ancillary (non-UR) services.
• Create Charges: Document charges through Group Sessions and Evaluations. This includes examples for both Level of Care and Ancillary billing.
• Send Charges to RCM: Learn how to review, edit, and submit charges to RCM using the Billing Audit Tool (BAT) Report.
• Batch Transmission Errors: Discover common issues and their resolutions when transmitting charges to the RCM.
• Private Pay: Discover how to create and bill private-pay patients using the integration.
• Billing Report - Errors and Warnings: Discover common alerts/warnings on the Billing Report and how to resolve them.

Settings

While most of this configuration is completed during your implementation process, these articles are available for reference when you need to make future updates, additions, or changes.

• Patient Tab

  From the Patient Settings tab, you can configure the following items:

  • Levels of Care: Determine how each LOC offered by your organization will be billed for per-diem services.
  • Payment Methods: Ensure Payment Methods have the correct category.
  • Patient Billing Tab: Add the Billing Report to the patient chart for per-patient billing
  • Do Not Bill Reasons: Create a selection list of Do Not Bill Reasons for use on the Billing Report.

• Billing Tab

  From the Billing Settings tab, you can configure the following items:

  • Create Billable Services: Learn the process from start to finish in both products.
  • Codes: Create CPT, HCPCS, and Revenue codes.
  • Services: Create service codes to allow authorization numbers to be applied to specific services.
• Key Settings
  • Kipu RCM Konnector: The Kipu RCM Konnector ensures that the data in the Kipu EMR is routed to the correct facility in the RCM with the appropriate rendering provider.
  • Bill by Building: Billing by Building allows users to choose which RCM facility and rendering provider the billable items should be associated with based on the Building the patient is assigned to.
  • Bill by Program: Billing by Program allows users to choose which RCM facility and rendering provider the billable items should be associated with based on the Program the patient is assigned to.
  • User Roles and Permissions: Review the roles and permissions to assign to your billing users. 
  • Configure Group Sessions/Evaluations: Set up per-diem and ancillary billable templates. 
  • Rendering Providers: Configure the system to send specific Rendering Providers to the RCM, if needed.