Group 137.png
Eligibility.png

CLAIMS ATTACHMENTS

275 CLAIMS ATTACHMENTS WORKFLOW

Smart corrections and validation for SNIP L1-L7 & codes

FEATURES

275 Real time and Batch ATTACHMENTS

  • Receive 275 Claim Attachment Transactions via EDI and security. Route the request to membership system using intelligent router. Get and generate the response.

  • Receive 275 Claim Attachment Transactions via EDI request file from Trading Partners . Route the request to membership system using intelligent router.

  • Create and send 999, TA1 based on SNIP L1 / L2 Validation results based on the Companion guide configuration. Outgoing 999 is attached to Graph Node and available to audit

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

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

SINGLE VIEW OF EDI

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

  • Create Manual 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

  • View incoming requests and outgoing responses, track response time , track AAA, Track compliance.

  • Attach to Prior Auth or Claims 

  • Link Prior Auth data and Attachments to claims

VALIDATION TEMPLATES

  • Companion guide templates

  • SNIP L1 to L2 rules Templates

  • Attach 278 to member view for customer service

CLEARING HOUSE INTEGRATION

  • Integrate with Availity 

  • Integrate with Change Healthcare

  • Integrate with Office Aly and other clearing houses

GENERATE 275

  • Send 275 Request to State or other plans

  • Receive 999, TA1

  • Manage workflow for incoming responses

  • Manual Data entry 

BENEFITS

  • Clear view of prior auth approvals and claims approval
  • 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

ATTACHMENTS EDI

275 ATTACHMENTS

  • Enable 275 EDI Transaction

  • Receive and track attachments

  • Link Attachments to claims and Prior authorizations

  • Route request to multiple membership systems

  • Availity Integration

  • Convert Response to EDI and JSON for multi channel support

Claims Management.png

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. 

HIPAAS-Lockup-Vertical-Stacked-Dark.1.png