HiPaaS 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 modelling support
End-to-End EDI Management
Enable integration, simplify healthcare standards and reconcile EDI data issues
Key Features include:
- Any to any integration with support for custom workflows
- High performance/availability
- Customizable GUI for reporting, metrics and monitoring
- Data Lake and Containers enabling predictive modelling, machine learning and AI
- Role-based access supports an extension to IT Support, Customer Service & Business Operations
Benefits of HiPaaS:
- Dynamic multi-threaded processing and validation engine
- Simultaneous multistage processing
- Robust exception handling
- Transactions continue to flow no matter the data or format
- Process transactions singularly, not in batch
- Transparency: exceptions are identified and accounted for
- Container-based deployment
HiPaaS EDI Highlights
837 Claims
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
834 Enrollment
• Business workflow UI to pre-scrub and validate prior to loading into membership system
• 834 Enrollment Intake & Submission including Daily and 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
835 Payments:
• 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 Premium Payments:
• Load current and historical premium payment files
• Reconcile file and payment level metrics
• Rate Code Validation
• Reconcile 834 to 820 payments
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
Real-Time Transaction Management
Real Time Eligibility (270/271) and Claims Status (276/277)
- Ability to Support real-time or batch processing
- Send/Receive 270/271, 276/277 transactions
- Real-time 27X API’s for Insurance, Medicare, Medical and Dental providers and trading partners
- CAQH CORE Compliant
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
Encounter Management
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
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
Payer Case Study
Implementation of multi line-of-business real-time solutions that meet strict COHR compliance operating requirements.
Demonstrative capacity to process 2,000,000+ messages per hour.
End-to-End Claims monitoring, traceability and reconciliation functionality reducing processing delays and administrative costs associated with “orphan claims”
Improved data quality and first pass rates associated with SNF Edit functionality (L1 – L7), custom data validation, member/provider match logic and advanced business rules.
Proven ROI exceeding 40% administrative savings associated with improvements to data quality, processing efficiencies and platform stability.
