278 Real time and Batch PRIOR AUTH

• Receive 278 Prior Authorization Transaction and security. Route the request to membership system or Pega system using intelligent router. Get the and manage 278 Prior Authorization Transaction responses, generate and send 278 X12 responses

• Receive 278 Prior Authorization Transaction request file from Trading Partners . Route the request to membership system using intelligent router. Get the 278 Prior Authorization Transaction response, generate and send 278 X12 response

• 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

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

SINGLE VIEW OF EDI

• View Prior Auth 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 and response time

• Manage Prior Auth Approval or Denial Workflow

• Attach Prior Auth data 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 278

• Send 278 Request to State or other plans

• Receive 999, TA1

• Manage workflow for incoming responses

• Manual Data entry