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
HipaaS Store and retrives healthcare data in Neo4j GraphDB. X12, HL7, FHIR modeling
Autoscale with Kubernetes. Deploy on Cloud or On Prem - AWS, Azure adn Google supported
Everything is Healthcare API. Access any X12, EDI segment or element via API
Support for all Healthcare data formats – EDI, HL7, FHIR, NCDP and more. using Boomi