API Driven EDI
SNIP L1-L7 EDI Validation
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
End to End EDI Reconcile
HiPaaS enables 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.
837 Claims Management
Improve the overall intake processing of your claims with out-of-box processes to enable 837 I, P, D intake
Generate, validate, send, receive and reconcile claims transactions
Quickly reconcile rejected claims with mechanisms to route and automate claims edits
277CA transaction response
999, TA1 Responses
276/277 Claims Status
Real and Batch Claims Status (276/277)
Ability to Support real-time or batch processing
Send/Receive 276/277 transactions
Real-time 27X API's for Insurance, Medicare, Medical and Dental providers and trading partners
CAQH CORE Compliant
835 Payments Management
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
820 Payments Reconcile
820 Premium Payments:
Load current and historical premium payment files
Reconcile file and payment level metrics
Rate Code Validation
Reconcile 834 to 820 payments
834 Enrollments Management
Business workflow UI to pre-scrub and validate prior to loading into membership system
834 Enrollment Intake & Submission Daily Files
Compare & reconcile member data against any membership system.
Support for multiple companion guides and scalable to accommodate multiple trading partners
Automate your membership updates including retro changes
Send or receive standard or custom 834 file formats
Ability to fix errors on file and re-submit with configurable validations including: NPI, zip code vs state/address, Provider Taxonomy checks, Rate code comparison and Aid code validation
834 Enrollments Full Reconcile
834 Enrollment Intake & Submission Monthly Full File Compare
Compare & reconcile member data against any membership system.
Support for multiple companion guides and scalable to accommodate multiple trading partners
Automate your membership updates including retro changes
Send or receive standard or custom 834 file formats
Ability to fix errors on file and re-submit with configurable validations including: NPI, zip code vs state/address, Provider Taxonomy checks, Rate code comparison and Aid code validation
270/271 Eligibility Service
Real and Batch Claims Status (276/277)
Ability to Support real-time or batch processing
Send/Receive 276/277 transactions
Real-time 27X API's for Insurance, Medicare, Medical and Dental providers and trading partners
CAQH CORE Compliant
275 Attachments
275 with Attachments Intake
Additional information claim responses (277RFAI)
Attachments loaded in viewer system related to Claims - Claims Viewer
278 Pre Auth
Authorization Management (278):
Robust authorization solution for real time 278-11 and 278-13 processing
Ability to Support real-time or batch processing
Integrate with your existing authorization workflows
274 Provider Directory
Create, audit and send 274 Provider Files
Manage Submission and validate the receipt and response 274 from any entity
Provider directory API
837 Encounter Management (I)
Inbound Encounters:
L1-L7 Validations + Custom rules and edits / by state requirements (out of the box)
Acceptance and Rejection with 999 (partial or full)
Load into any system of record (HealthEdge, Facets, QNXT)
Manually fix rejections and reconcile claims with End to End tracking
Post-processing logic and business workflows to filter and fix errored out encounters
837 Encounter Management (O)
Outbound Encounters:
Generate Encounter data/files from EHR of choice or a staging database
Send validated encounters to state with custom edits
Hold, fix or discard/regenerate error encounters in HiPaaS
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
Architecture of Future
Lead with HiPaaS
Built with future in mind - Digital, Cloud Computing, On Premise, Graph Data, Containers, Kubernetes and more
Case Studies - Healthcare Insurance
HiPaaS as Enrollment Clearing House
Currently, there are no Clearing house in market that handle enrollment data. HiPaaS provides enrollment clearing house capability for Benefit administration companies or large corporates.
Enrollment Full File Compare – DHCS CA
When it comes to end of month full file activities, Insurance companies spend lot of time in reconciling data. Net result of it delay in
HPS Enrollment Integration
HiPaaS provides HPS enrollment integration for Payers with QNXT. HiPaaS tracks all files and enrollments submitted via HPS , compares with data in QNXT and
Availity Integration
HiPaaS platform used as backbone to integrate Availity Portal by leading Insurance company across 15 states. HiPaaS Availity plugin enables intake of all EDI transactions
Real time Eligibility with QNXT
HiPaaS provides out of box QNXT plugin to get Eligibility data and enable 270/271 real time transaction and API. The QNXT interface is developed using
Real Time Eligibility with HETS, Facets and Mainframe
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
Case Studies - Hospitals
Paper to Digital OCR integration for EHR systems
Client required a scalable and highly available solution for connectivity to multiple EHRs and payers, with interface for patient management and document services (OCR). HiPaaS
Clinical Data Extracts for Analytics Engine
Client need was to develop and maintain automated EHR clinical data extracts to be sent over for ingestion to a third-party Analytics engine. HiPaaS team
Genetic predisposition to Cancer
HiPaaS is used by leading Cancer Research firm to collect genomics data which is then used for Prediction scoring. Patients can get online prescription from
Diabetes and Kidney Health Management via HiPaaS
HiPaaS used for Diabetes and Kidney Health Management by Medical Group. HiPaaS collects following events from various sources – 1. CCDA information about Patient History
Population Health Management via HiPaaS
HiPaaS used for Population Health Management by leading Medical Group. HiPaaS collects following events from various sources – 1. CCDA information about Patient History 2.
Post Surgery Real Time AI Driven Monitoring
Proud of HiPaaS team. HiPaaS Go Live with ML/AI Model for leading Cancer Research Hospital to reduce in-hospital mortality rate. Model is designed to monitor
#hipaas
Why HiPaaS is #1 choice for migrating healthcare EDI to Cloud ?
HiPaaS is all-in-one HIPAA compliant cloud platform – API, EDI and HL7 connectivity with informative and interactive dashboard. HiPaaS helps you to migrate healthcare applications, APIs,
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