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CLAIMS STATUS CHECK

276/277 CLAIMS STATUS CHECK PROCESS

Smart corrections and validation for SNIP L1-L7 & codes

FEATURES

276/277 CLAIMS STATUS CHECK

  • Receive CORE compliance Claim status using SOAP XML and security. Route the request to claims system using intelligent router. Get the claims status response, generate and send 277 X12 response

  • Receive Claim request file from Trading Partners . Route the request to claims system using intelligent router. Get the claims status response, generate and send 277 X12 response

  • Real time Claims Status 276/277 from HETS CMS

  • 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

  • 276 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 EOB FHIR resources

SINGLE VIEW OF EDI

  • View Claims Status data on HiPaaS UI. Check the file load status, Check the 276 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 to Claims view

CLEARING HOUSE INTEGRATION

  • Integrate with Availity 

  • Integrate with Change Healthcare

  • Integrate with Office Aly and other clearing houses

LOAD 276/277

  • Load Claims Status files from State or external Plans

  • Send 999, TA1

  • Validate incoming 276 files

  • Manual Data entry of Status

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

CLAIMS STATUS CHECK

276/277 Real time and Batch Claims Status Check

  • Enable Realtime and Batch 276/277 Transaction

  • CORE Compliance

  • Provide real time view of Adjudication status

  • HETS and CMS connectivity

  • Route request to multiple membership systems

  • 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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