Medicare, Medicaid and Marketplace across 18 states
Processing 10M+ Claims, Enrollments, Eligibility and Claims payment
Hospital Remittance & Revenue Management
Reconciling 20M Claim payments per year
DHCS Full File Compare
Compare Medicare, Medicaid and DHCS Full file with QNXT and update changes
Medicare HETS Real time Eligibility
Check eligibility with HETS CMS across all channels and multiple systems
Clams & Encounter Management
L1-L7 Validations, Medicare and state rules for covered and not covered code sets. Improved data quality

Make Artificial Intelligence Real
Simplifying Healthcare EDI​

We help you rethink Healthcare solutions

HiPaaS Platform

Services

HiPaaS EDI Platform

Manage Inbound or Outbound Claims 837 I, P, D from various Trading partners, Clearing houses. SNIP Level 1-7 validations. 999 and 277CA generation. Claims Status interfaces. Quickly reconcile rejected claims with mechanisms to route and automate claims edits
277CA transaction response
999, TA1 Responses Account for every $ of claim payment. Reconcile 837 to 835 Payments 

Manage Outbound Encounters Submission to State or Medicare, Medicaid.  SNIP Level 1-7 validations. 999 and 277CA generation. Outbound Encounters: 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 Encounter error corrections and Encounter Reporting.

Manage Inbound or Generate Outbound 835 Claims Payments. Reconcile with 837 Claims. Reconcile with Remittance and Treasury and Lockbox.

Implement real time transactions with fastest API driven interfaces integrated with QNXT, Facets and Healthedge for Claims Status

270/271, 276, 274, 278 Pre Auth

Implement 275 Claims Attachments and Clinical attachments

Manage out of box 999, TA1 and 277CA transactions

Out of box integration wiht Availity Clearing house and QNXT for all transactions

Implement all real time transactions with fastest API driven interfaces integrated with QNXT, Facets and Healthedge. 

270/271, 276, 274, 278 Pre Auth

Manage inbound and outbound enrollments from state, Medicare and Large groups. Compare with membership data in real time and manage updates. Manage Add, terms, changes, voids, term by absence and various overlapping scenarios. Business workflow UI to pre-scrub and validate prior to loading into membership system 
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

Compare Full file from Medicare, state plans with Membership and identify changes

Implement Provider Directory and directory submission

Robust Prior authorization solution for real time and batch 278-11 and 278-13 processing and inquiry. Pega integration

Manage 820 Payments and reconcile with enrollments data

Integrated with HPS enrollments for commercial and group plans to handle multiple coverages.

Manage various other formats for claims, patient data

HiPaaS Core Products

HiPaaS Solutions

Insurance Payers Solutions

Manage Claims from various Trading partners, Clearing houses. SNIP Level 1-7 validations. 999 and 277CA generation. Claims Status interfaces

Implement all real time transactions with fastet API driven interfaces integrated with QNXT, Facets and Healthedge

Manage inbound and outbound enrollments from state, Medicare and Large groups. Compare with membership data in real time and manage updates

Compare Full file from Medicare, state plans with Membership and identify changes

Implement CMS FHIR Interoperability mandate with easy interfaces to translate EDI data 274, 837 and 834 data. Easy to implement and enable with built in mappings.

Out of box integration wiht Availity Clearing house and QNXT for all transactions

Integrated with HPS enrollments for commercial and group plans to handle multiple coverages.

Hospital Providers Solutions

Reconcile 837 Claims to 835 ERA remittance and Bank files

HETS CMS real time eligibility API, MBI Lookup and  FISS/DDE emulator

Collect real time Vitals, Labs and run AI algorithms to manage cases like Sepsis monitoring, mortality rate monitoring, population health and others 

Stream real time HL7 data, FHIR resources and APIs

Context and Chat driven Mobile app integrated with MyChart. Helpful to manage telehealth and chat with clinical staff.

Collect and analyze patient data in one Graph repository. Connect all HL7, FHIR and Revenue data together.

Coding validation and claims submission, with AI driven Claims module. Reduce claims rejection. Mapped with Medicare covered vs non covered codesets.

HiPaaS Engineering

Healthcare Neo4j GraphDB

HipaaS Store and retrives healthcare data in Neo4j GraphDB. X12, HL7, FHIR modeling

Kubernetes Cluster

Autoscale with Kubernetes. Deploy on Cloud or On Prem - AWS, Azure adn Google supported

Secure Healthcare API

Everything is Healthcare API. Access any X12, EDI segment or element via API

Healthcare Interoperability Solved

Support for all Healthcare data formats – EDI, HL7, FHIR, NCDP and more. using Boomi

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