AI-enabled EDI validation & functionality
Make Artificial Intelligence a Reality
Simplifying
Healthcare
EDI
Complete Healthcare
EDI functionality:
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)
State Submissions
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 Pricing
HiPaaS EDI Lite
Per Transaction-
L1/L2 Validation
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L3-L7 Validation
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Data Load & QNXT Load
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Front End Data View
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Unlimited Volume
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Access Via API
HiPaaS CMS Interop
FHIR Repository-
USCore Resources
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Da Vinci - Carin, Plan mappings
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Data Load and Mapping
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Oauth, Consent Mgmt
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Unlimited Volume
HiPaaS
HL7 Streaming-
All HL7 Transaction
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Loaded in Database
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Front End View
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Access Via API or Kafka
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Unlimited Volume
HiPaaS
Enterprise-
L1/L2 Validation
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L3-L7 Validation
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Data Load & QNXT Load
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User Experience
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Unlimited Volume
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.
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