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ENROLLMENTS COMPARE

834 ENROLLMENTS VALIDATION AND LOADER

Smart corrections and validation for SNIP L1-L7 & codes

FEATURES

834 ENROLLMENTS LOADER

  • Load 834 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 834 Files

  • L1/L2 Validation of 834 Files

  • Load 834 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 834

SNIP L1-L7 VALIDATIONS

  • SNIP L1 / L2 Validation of 834 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 

VALIDATION TEMPLATES

  • 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

CLEARING HOUSE INTEGRATION

  • Integrate with HPS

  • Integrate with Availity 

  • Integrate with Change Healthcare

  • Integrate with Office Aly and other clearing houses

GENERATE 834 

  • Generate 834 files

  • Send to various Payers or Providers

  • Create 834 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

FULL FILE COMPARE

  • Configure rules to compare with membership data.

  • Connect with membership data and compare member demographics, rate code, dual plans, coverage overlap, retro, term by absence, changes and more.

  • Available for full file compare, audit file compare

  • Identify Transactions - ADD, Change, Audit, Term, Term by absence, Retro, Void

  • Coverage Overlap; Handle complex scenarios of coverage overlap, coverage split, EXT and INT segments , future coverages, retro coverage changes

  • Identify changes to rate codes and rate code calculations

  • Identify dual plan changes and handling

  • Compare every change file.

  • Handle multiple enrollments changes in one file.

  • Audit file compare

  • Manage errors queues and workflow for mismatch in compare and changes to be applied to membership systems

  • Generate ID card files from Recent membership data changes based on new files

SMART AI CORRECTIONS

  • 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.

FULL API INTEGRATION

  • 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

  • 834 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 Coverage EOB FHIR resources

SINGLE VIEW OF EDI

  • 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

NOTIFICATIONS

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

BENEFITS

  • Accurate and real time Benefits ​
  • Access to care for Members with right membership data
  • Accurate coverage and rate codes
  • Manage dual coverage and overlaps
  • Process retro changes to membership
  • Accurate PCP and premiums
  • Reconcile Premium payments with Eligibility

ENROLLMENTS MANAGEMENT

834 ENROLLMENTS MANAGEMEN

  • 834 File Validator and Loader

  • Configure Custom Edits

  • Support multiple Formats for 834

  • Compare with Membership before loading

  • Full file compare , Audit file compare

  • Check pcp, rate codes, dual plans, coverage, retro changes

  • Generate Outbound 834

  • Generate Outbound custom membership files for providers

  • Track Membership data to ID card generation

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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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