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ELIGIBILITY CHECK

270/271 ELIGIBILITY CHECK PROCESS

Smart corrections and validation for SNIP L1-L7 & codes

FEATURES

270/271 Real time and Batch Eligibility

  • 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 AI CORRECTIONS

  • Smart correction on repeating data error

  • Automated AI learning rules to correct data

  • Convert Outgoing Response to JSON for Member Portal and other channels

FULL API INTEGRATION

  • 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

SINGLE VIEW OF EDI

  • 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

NOTIFICATIONS

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

SNIP L1-L7 VALIDATIONS

  • SNIP L1 / L2 Validation of Request

  • Track Compliance

  • Track Bx Score

VALIDATION TEMPLATES

  • Companion guide templates

  • SNIP L1 to L2 rules Templates

  • Attach 270/271 to member view

CLEARING HOUSE INTEGRATION

  • Integrate with Availity 

  • Integrate with Change Healthcare

  • Integrate with Office Aly and other clearing houses

LOAD 270/271

  • Load Eligibility files from State or external Plans

  • Send 999, TA1

  • Validate incoming 270 files

  • Manual Data entry of Benefits

BENEFITS

  • Scale to support large volumes of requests
  • Provide real time status of transactions
  • Use same data for Member Portal, Provider Portal and
  • Customer service via API
  • Timely Response to Providers
  • Transparent view to Providers

ELIGIBILITY CHECK

270/271 Real time and Batch Eligibility Check

  • Enable Realtime and Batch 270/271 Transaction

  • CORE Compliance

  • HETS and CMS connectivity

  • Route request to multiple membership systems

  • QNXT, QXI integration

  • Availity Integration

  • Convert Response to EDI and JSON for multi channel support

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GET STARTED

Invest your time where it's needed. Set it up once and auto-scale

HIPAAS supports AWS Cloud, Azure or GCP or On-Prem for Enterprise customers. 

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