AI-enabled EDI validation & functionality
Make Artificial Intelligence a Reality
Claims, Enrollments, Eligibility, Pre-Authorizations, & Payments.
A fully integrated Healthcare EDI suite
834 Enrollments Management and Full File Compare
834 Enrollment Validation & Processing
Compare & reconcile member data against any membership system.
Automate your membership updates including retro changes
Ability to fix errors on file and re-submit with configurable validations including: PCP, NPI, zip code vs state/address, Rate code comparison, Aid code, Dual plans validation
Claims Management (837) & Claims Payments (835) Reconcile - Revenue Management
Quickly reconcile rejected claims with mechanisms to route and automate claims edits
277CA transaction response
999, TA1 Responses Account for every $ of claim payment.
Generate or receive standard or custom 835 file formats.
Ensure 835 files are balanced with business workflows
Reconcile 837 to 835 Payments
27x Real Time Eligibility, Claims Status, Pre-Auth, Claims Attachments, and Provider Directory
Real and Batch Claims Status (276/277)
Create, audit and send (274) Provider Files
275 with Attachments Intake
Additional information claim responses (277RFAI)
Authorization Management (278):
Robust authorization solution for real time 278-11 and 278-13 processing
Real-time 27X API's
CAQH CORE Compliant
837 Encounter Management (Inbound)
L1-L7 Validations + Custom rules and edits / by state requirements
Acceptance and Rejection with 999 (partial or full)
Load into any system of record (HealthEdge, Facets, QNXT, Database)
Manually fix rejections and reconcile encounters
Post-processing logic and business workflows to filter and fix errored out encounters
837 Encounter Management (Outbound)
Generate Encounter data/files from QNXT/System of choice or a staging database
Send validated encounters to state with custom edits
Hold and fix encounters errors
Load responses from different States (EVR, 999, 277CA, 835, text reports)
Keep up to date on State validation edits changes
Match your encounter edits to inbound
Make real-time decisions with EDI data
API driven validation configuration for L1 – L7 rules. AI driven auto correction and exceptions handling.
End to end EDI X12 Healthcare Functionality
Connect & Reconcile multiple Healthcare data sources
HIPAA L1-L7 Validation and Custom Rules Integration
Containers for predictive data model support
Healthcare EDI for Medicare, Medicaid and MarketPlace across 15 States.
HiPaaS provides out of box reconcile at file level and transaction level
Each claim, enrollments are reconciled
Dashboard providers capability to view results and manual edits.
HiPaaS EDI LitePer Transaction
Data Load & QNXT Load
Front End Data View
Access Via API
HiPaaS CMS InteropFHIR Repository
Da Vinci - Carin, Plan mappings
Data Load and Mapping
Oauth, Consent Mgmt
All HL7 Transaction
Loaded in Database
Front End View
Access Via API or Kafka
Data Load & QNXT Load
HiPaaS Platform Features
Store, locate, and reconcile healthcare data as it arrives using Graph DB
With HiPaaS Kafka stream large volumes of data in real time.
Support for all Healthcare data formats – EDI, HL7, FHIR, NCDP and more.
Autoscale with Kubernetes Cluster management and Docker containers.
DevCool HiPaaS Real-time Eligibility API (270/271) provides easy integration & high reliability – we have customer data to back it. What is HiPaaS Eligibility API? HiPaaS Eligibility