Replace Legacy EDI with AI driven EDI & Reduce Cost

EDIVal gives health plans, Medicare and Medicaid programs, TPAs and managed care organizations of every size a AI driven alternative to Edifecs—with configurable X12 validation, AI driven development and integrated deployment.

837 Claims 835 ERA 270/271 Eligibility 834 Enrollment 276/277 Status 278 Prior Auth 275 Attachments SNIP L1–L7

Build using AI

EDIVal is built, run and maintained end to end by AI agents—no developers to hire, no legacy platform to babysit.

End-to-End AI Build

Every rule and workflow built by AI agents.

No Developers Required

Configure through plug-ins, not custom code.

Easy to Maintain & Change

Update a rule in minutes, not a sprint.

Metrics & Notifications

Live operational visibility and alerts.

Validation & Rule Templates

Pre-built SNIP, mandate and partner rules.

High Scale & Performance

Built to handle high transaction volumes.

The Old Way
Developers to build and maintain
Dedicated EDI operations team
Legacy platform license fees
Weeks to change a single rule
EDIVal AI
AI agents build and maintain it
AI agents run operations 24/7
One AI-driven platform
Minutes to change a rule

Change the Rule—Not the Platform

No developers. No operations team. Let AI agents build and run your EDI—at a fraction of the cost of a legacy platform and team.

EDI AI Agent Features

EDI AI Agent Features That Automate EDI Operations

The HiPaaS EDI AI Agent coordinates file intake, validation, partner rules, exception handling and QNXT handoff—fully traceable and auditable.

File Pickup AI Agent

Detects and ingests files automatically.

Transaction & Partner AI Agent

Identifies file type, sender and partner rules.

Validation & Rules AI Agent

Runs SNIP checks and business rules.

Exception Explanation AI Agent

Explains failures in plain language.

QNXT Mapping AI Agent

Preps clean transactions for QNXT.

Live Dashboard AI Agent

Shows status, exceptions and next actions.

Complete X12 Validation and Processing

Validate, Convert and Control Every Healthcare Transaction

EDIVal combines configurable X12 validation, AI-assisted trading-partner setup, data conversion and healthcare-specific business checks in one scalable platform.

Comprehensive X12 Validation

Validate every transaction against:

X12 syntax and structural requirements
SNIP Levels 1–7
Situational rules
Implementation-guide requirements
Payer companion guides
Trading-partner-specific rules
Custom business and regulatory rules
AI-Assisted Trading Partner Setup

Use AI to accelerate onboarding and configuration:

Interpret companion guides
Recommend validation rules
Generate mappings and configurations
Identify differences between partner requirements
Test transactions before production
Reduce manual setup and maintenance
X12-to-JSON Conversion

Convert complex X12 transactions into developer-friendly JSON—and generate X12 from JSON, APIs, databases and other application data.

Bidirectional X12 and JSON conversion
Configurable field mappings
API-ready data structures
Validation before and after conversion
Faster integration with modern applications
Healthcare Business Validation

Go beyond format validation with healthcare-specific checks:

Covered and non-covered benefit checks
Member eligibility and enrollment validation
Membership-system verification
Provider and NPI validation
Code-set and reference-data checks
Duplicate and cross-transaction checks
Custom payer business rules
Built-In Generation Controls

Generate compliant X12 transactions with controls for:

ISA, GS and ST envelopes
Control-number generation and tracking
Transaction balancing
Segment and loop creation
Required and situational data
Code-set validation
Trading-partner configurations
Acknowledgment generation
Complete audit history
Healthcare Transactions Supported

EDIVal supports major healthcare transaction types, including:

834 — Benefit Enrollment and Maintenance
837 — Professional, Institutional and Dental Claims
835 — Claim Payment and Remittance
270/271 — Eligibility Inquiry and Response
276/277 — Claim Status Inquiry and Response
278 — Healthcare Services Review
275 — Additional Information to Support a Healthcare Claim
274 — Provider Information
999 — Implementation Acknowledgment
TA1 — Interchange Acknowledgment

One Platform From Validation to Integration

Configure rules, onboard trading partners, validate transactions, convert X12 data and generate compliant outputs—without maintaining multiple legacy EDI tools.

X12 Generation

Generate Compliant X12 Transactions From Your Existing Data

EDIVal uses AI to convert data from APIs, databases, applications and common file formats into healthcare X12 transactions—without custom developer scripts for every new source or partner.

Configure the transaction structure, trading-partner requirements and business rules once, then let AI generate consistent X12 output at scale.

Supported Source Formats

JSON
XML
CSV and flat files
Databases
REST APIs
FHIR resources
Application and core-system data

Generate Healthcare Transactions

834 — Enrollment and Maintenance
837 — Professional, Institutional and Dental Claims
835 — Claim Payment and Remittance
270/271 — Eligibility Inquiry and Response
276/277 — Claim Status Inquiry and Response
278 — Prior Authorization
275 — Additional Information and Attachments
274 — Provider Information

Built-In Generation Controls

ISA, GS and ST envelope generation
Control-number management
Segment and element mapping
Code-set validation
Required and situational-field validation
Trading-partner companion-guide rules
Balancing and reconciliation
Pre-submission SNIP validation
Acknowledgement generation and tracking

Generate, Validate and Deliver Through One Workflow

Every generated transaction can be validated against X12, SNIP, mandate and partner requirements before it is delivered to the receiving system or trading partner.

Compliance & Operational Intelligence

Monitor EDI Compliance and Operational Performance in Real Time

EDIVal's AI continuously monitors transaction quality, rule compliance, acknowledgements and processing outcomes across your EDI environment, giving you a traceable view without manual log review.

Dashboards and configurable reports help EDI, operations and compliance teams identify emerging issues, document controls and respond to regulatory or trading-partner requirements.

Compliance Monitoring
X12 and SNIP validation status
Mandate-rule coverage
Companion-guide compliance
Required-field and code-set validation
Acknowledgement completion
Control-number integrity
Duplicate-file and transaction monitoring
Complete validation and decision history
Operational Reporting
Inbound and outbound transaction volumes
File and transaction acceptance rates
Error and rejection trends
Processing turnaround time
Unresolved exception aging
Trading-partner performance
Recurring segment and rule failures
Acknowledgement status
Resubmission and correction activity
System and workflow performance
CMS & Regulatory Reporting Support

Configure reports and dashboards to support CMS-0057-F, state Medicaid and program-operational requirements.

Examples include:

Prior-authorization operational metrics
Enrollment reconciliation
Claims and encounter-data quality
Transaction timeliness
Exception and rejection analysis
Partner-compliance reporting
Audit evidence and rule history
Executive Dashboards

Give leadership a consolidated view of EDI volume, quality, compliance exposure, operational backlogs and partner performance.

From Technical Transactions to Actionable Operational Insight

EDIVal turns EDI processing data into reports that help technical, operational and compliance teams understand what is working, what is failing and where action is required.