Load 820 files with our scalable Enrollment Loader optimized to handle large load. Enrollment are loaded in Graph Database and available to process in seconds.

Trading Partner Setup

SFTP File Setup

API for Validating and Loading 820 Files

L1/L2 Validation of 820 Files

Load 820 files with our scalable loader in to Graph DB. Enrollments are loaded in Graph Database and available to process in seconds.

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

Run L2-L7 Validation Rules

Enrollments data available via API

Reconcile with Providers Outbound 820

SNIP L1 / L2 Validation of 820 before loading. Generate error file. The companion guide can be configured by Trading Partner, payer or provider. Companion guides can be changed on fly and tested with incoming files. Fully accept or Partial accept the claims files

Custom or out of box companion guide setup for L1/L2 Validations.

Configure complex validation and compare rules based 

Companion guide templates

SNIP L1 to L7 rules Templates

Compare Codesets, ICD templates

Covered and Not Covered template

NPI lookup template

Other data templates

Entire EDI data is available to access via Rest API or configured to stream on Kafka Queues

Integrate with HPS

Integrate with Availity 

Integrate with Change Healthcare

Integrate with Office Aly and other clearing houses

Generate 820 files

Send to various Payers or Providers

Create 820 files with our scalable engine optimized to handle large load. Connect to your database to get data and create files and batches

Validate the files before sending outbound

Manage outgoing Batches / Files Batch outgoing claims in groups and files by receiver. Manage the batch submission and results

Receive and Track 999, TA1

Compare the incoming premium data to membership coverage data at the time of premium payment and identify differences and missed payments by state or CMS

Compare inbound Premium payments to outbound vendor and provider membership payments and coverage sent to provides. Validate PCP assignments and changes

Smart correction on repeating data error

Automated AI learning rules to correct data

Codes and values to mark for rejections

Compare with other file or external data source

Audit every correction

Manual Corrections via Work queues

Auto Correction and Auto Learning - Configure and setup auto corrections of repeating data mistakes by trading partners and providers so that the claim can be processed. Define workflow to hold the claims for specific conditions.

Everything in EdiVal is accessible via API. Validation results and 999, TA1  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

Get Enrollments API - All the data are loaded are available to access from external systems by get claims RESTful API based on filters like filename, claim id, status - accepted, rejected, all or by claims type, claim date

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

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

Create missing enrollments via UI 

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.