eCW Fax Server Setup Guide

The eClinicalWorks fax server is the part of eCW that files inbound faxes into the chart and sends outbound faxes from eCW's own screens. Without one, faxing in an eCW practice is a manual job. This guide covers what the fax server does, the hardware eClinicalWorks will ask you for, how to get one set up, and how to take the modem and analog phone line out of the picture afterwards. It reflects eCW v12 as deployed in our clients' practices.

Why Faxing Still Matters in Healthcare

Referrals, records requests, prior authorizations, pharmacy communications, lab and imaging results: the practices, payers, and pharmacies you exchange them with still run on fax, and will for years. For most medical practices the question isn't whether to fax, it's how to fax without a person standing at a machine, scanning, and filing.

What the eCW Fax Server Does

eClinicalWorks handles faxing through a dedicated on-site fax server: a Windows workstation running eCW's fax software, historically with a fax modem and an analog phone line attached. It does two jobs:

• Inbound — faxes arriving on the practice's number are filed into eCW, where staff match them to patients and work them from the chart. Nothing is scanned, downloaded, or dragged in by hand.
• Outbound — staff fax from eCW's own screens, with eCW cover pages, and the fax server sends it.

The fax server is the integration point. Anything that wants faxes to flow into and out of eCW automatically—including NEXpbx Fax Connect—works through it. That's why the first step for a practice without one is to get one set up.

Faxing Options Compared

What the Fax Server Needs

eClinicalWorks sets up and supports the fax server itself; your part is providing the machine and, until you move to Fax Connect, the modem and line it plugs into. This is what they'll expect:

Whether eClinicalWorks itself runs on your own server or is cloud-hosted doesn't matter here. The fax server is on site either way, and that's what Fax Connect works with.

The Problem Is the Phone Line, Not the Fax Server

The fax server does its job well. The trouble is the analog line and modem it was built around:

• One line, two directions. While an outbound fax is going out, inbound callers get a busy signal and may fail. High-volume periods create backlogs, and staff spend time re-sending. Adding a second modem means Windows Server, since Windows 11 Pro supports only one.
• Modems fail silently. When a modem stops working, eCW rarely says so—outbound faxes just sit on Sending. One practice we moved onto NEXpbx found its faxes had been showing Sending for over a year.
• The copper is going away. Analog lines are being retired across the country. A fax server that depends on one has a shutoff date, whether or not anyone has told you when.

The NEXpbx Fax Connect Solution

NEXpbx Fax Connect for eClinicalWorks keeps the fax server and takes the phone line out of the picture in both directions:

1. Inbound faxes arrive over the internet and are handed to your eCW fax server, rather than coming down a phone line
2. Outbound faxes leave eClinicalWorks through the eCW Fax Bridge, over the internet, with the result reported back into eCW
3. Staff keep using the same eCW fax screens; the portal and print to fax are there for everything else
4. No busy signals, no modem to fail silently, and no analog line to keep paying for

The eCW fax server itself stays in place; only the hardware hanging off it goes. A NexgenTec technician installs both pieces remotely in one short session, and the practice's existing fax numbers are ported to NEXpbx so nothing changes for the people who fax you.

What Happens to an Inbound Fax

Every fax is archived in the portal and tagged as an automatic delivery, so your audit trail distinguishes it from one someone filed by hand. Until a fax server is in place, the portal and print to fax work on any plan.

What Happens to an Outbound Fax

The eCW Fax Bridge is installed on your eCW fax server by a NexgenTec technician, in the same session as Fax Connect receive. It sits between eClinicalWorks and NEXpbx: each outgoing fax travels to NEXpbx over an encrypted connection instead of through the modem, NEXpbx transmits it over the phone network, and the result is reported back into eCW within about 30 seconds of completion—Completed, or Failed with a plain-language reason such as "the receiving number never answered as a fax machine."

• Nothing in eCW is modified — nothing is reconfigured; cover pages and fax screens are exactly as they were.
• Queues safely — if the internet connection drops, faxes wait on the server and go out when it's back. eCW shows them as pending, never lost.
• Reversible — we can switch sending on or off from our side at any time; switching it off hands the server back to its original fax software within minutes.
• Self-maintaining — the bridge updates itself outside office hours and recovers on its own if anything stops it. Documents are removed from your server as soon as each fax is delivered.

Every sent fax also appears in the portal with its pages and transmission receipt, labelled eCW so you can tell how it was sent. Both pieces report their health under Fax › Settings › Connected apps in the portal, with a plain Working / Needs attention / Offline status and what to check if something's wrong.

Sending: Portal Access and the Fax Printer

Outbound faxing doesn't stay tied to eClinicalWorks either. Every plan includes access to the NEXpbx Fax Portal, which gives staff two more ways to send:

• From the browser — sign in on desktop or mobile, pick the line, enter the number, attach the PDF. Multiple files merge into one fax, and cover pages are generated rather than retyped.
• New Straight from eClinicalWorks — add the fax as a printer on Windows 10, Windows 11, or macOS using the operating system's built-in printing standard, then print to it from eCW or any other application. No client software, no special driver. The print job arrives as a draft in that person's Drafts folder, where they add the cover page and confirm the number before sending.

Accounts are per-person with two-factor sign-in and per-line permissions, so every outbound fax is attributable to the staff member who sent it. Transmission receipts and 13 months of searchable history come with it.

Pricing

Plans are priced on pages per month. There are no per-page overage charges—a line pauses at its allowance and resumes next month, or immediately if you move up a plan. Fax Connect—receiving and the eCW Fax Bridge—is included on Fax 12000 ($89.99/month) and above:

Lower-volume plans start at $9.99 for 300 pages a month if you don't need the eClinicalWorks integration. See our full cost comparison against eCW Cloud Fax.

The Path, Start to Finish

Phase 1: Get the fax server set up (with eClinicalWorks)

1. Provide a dedicated Windows 11 Professional workstation with a free PCI-E slot
2. Install a Mainpine fax modem and its drivers
3. Connect the dedicated analog phone line to the modem
4. Have eClinicalWorks configure the fax server and its eCW integration
5. Test send and receive from eCW

Already have a working eCW fax server? Skip straight to phase 2.

Phase 2: Take the phone line out of the picture (with NexgenTec)

1. Pick a Fax Connect plan (Fax 12000 and up) based on your monthly page volume
2. We port your existing fax numbers to NEXpbx
3. A NexgenTec technician installs Fax Connect and the eCW Fax Bridge on the fax server, remotely, in one session
4. Confirm both directions under Connected apps in the portal
5. Retire the modem and cancel the analog line

Not sure whether you have a fax server, or which phase you're in? Talk to us—it's a five-minute conversation.