HiPaaS AI EDI Copilot analyzes eligibility, claims, payments, denials, attachments, and logs — delivering clear root cause, denial risk, and next-best actions for faster revenue cycle resolution.
Coverage, copay, deductible, authorization rules.
Claim loops, service lines, NPI, CPT/ICD validation.
CAS codes, payment variance, underpayment review.
Claim status, payer responses, follow-up guidance.
Clinical document recommendation and package guidance.
Gateway timeouts, trace evidence, operational RCA.
High-risk claims detected before submission
Payment variances identified per 10k claims
Faster RCA across EDI workflows
AI assistance for RCM and support teams
The Copilot explains failures, predicts denials, and recommends next-best actions with traceable EDI evidence.
Reads 270/271, 837, 835, 276/277, 275 transactions plus gateway logs and HiPaaS reports. No data leaves your tenant.
Connect EHR, RCM, PMS, EDI gateway, clearinghouse, payer responses, and operational logs — transforming raw X12 into root cause, denial risk, and guided revenue actions.
Patient, claim, encounter, and billing data from source systems.
Routes 270, 837, 276, 275, 835, and payer responses.
Normalizes segments, validates loops, and detects missing data.
Explains issues, predicts denial risk, and recommends action.
HiPaaS automates healthcare EDI transactions from clearinghouses, CMS, and trading partners, validates them through SNIP levels 1–7, and generates TA1, 999, and acknowledgements automatically — for Medicare, Medicaid, MediCal, State plans, Marketplace, and commercial.
Claims (837), Enrollment (834), Payments (835), Eligibility (270/271), Prior Auth (278), Attachments (275).
Validate integrity, requirement, balancing, situational, code-set, product, and trading-partner rules.
Generate TA1, 999, and business acknowledgements automatically on ingest.
Automate exchange with clearinghouses, CMS, and partners across MLLP, SFTP, and APIs.
Medicare, Medicaid, MediCal, State plans, Marketplace, and large-group commercial.
Upgrade off expensive or custom EDI platforms to a modern, AI-assisted engine.
Onboard trading partners and connect clearinghouses, CMS, and payers.
Configure transaction mappings and companion-guide rules — no code.
Run SNIP L1–L7 and auto-generate acknowledgements.
Monitor, reconcile, and resolve exceptions with full audit trails.
Claims, enrollments, payments, eligibility, prior authorization, attachments, and claim status.
