Receive CORE compliance Eligibility Check using SOAP XML and security. Route the request to membership system using intelligent router. Get the benefits response, generate and send 271 X12 response

Receive Eligibility Check request file from Trading Partners . Route the request to membership system using intelligent router. Get the Eligibility Check response, generate and send 271 X12 response

Send 999, TA1 Response 

Smart correction on repeating data error

Automated AI learning rules to correct data

Convert Outgoing Response to JSON for Member Portal and other channels

Everything in EdiVal is accessible via API. Validation results and 999, TA1 and 277CA can be accessed via API

For Realtime access – Call API with the Payload data.

For Batch access, load the file to S3 bucket and call the API with filename. 

API response includes EDI Validation Results:

• 999 Response

• TA1 Response

• HTML with error

Trading Partner Information  – You can use it to validate Trading partner

API are available for access claims, enrollments and all EDI data – validated or errored 

APIs are available to run complex query and lookup any data EDI data element

Prebuilt mappings, connectors and integration to QNXT, Facets and healthedge systems

Route Request to multiple Membership systems

270 Kafka Server Stream incoming claims data in kafka queue to be accessed by other applications.

EDI to FHIR mapping - Prebuilt EDI to FHIR mapping with USCDI US CORE Coverage FHIR resources

View Eligibility data on HiPaaS UI. Check the file load status, Check the eligibility validation and compliance status. Volume analysis. Find any claim and claim line items. Drill down on validation error

Create Manual Benefits entries

Powerful dashboard gives audit tracing across files and transaction level

Plugin any BI tool to write your own analytics

Real time visibility to data as it is validated and Loaded

Realtime visibility to edi errors and corrections

Audit trail of every change

Same data view for edi analyst and customer service

Views and Alerts Setup different business threshold alerts and notify business. Define analysis views by Provider, by trading partner, Submitter and others.

SNIP L1 / L2 Validation of Request

Track Compliance

Track Bx Score

Companion guide templates

SNIP L1 to L2 rules Templates

Attach 270/271 to member view

Integrate with Availity 

Integrate with Change Healthcare

Integrate with Office Aly and other clearing houses

Load Eligibility files from State or external Plans

Send 999, TA1

Validate incoming 270 files

Manual Data entry of Benefits