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 is used by leading Hospitals and Healthcare insurance companies to implement ML/AI algorithms in data pipelines`

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

Modularized End-to-end Encounter processing including Submission, Edits, Reconciliation and Audits

  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.

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HiPaaS™ is trademark of Devcool Inc.

A HIPAA compliant Microservices-based Healthcare common platform being online non-downloadable software to enable data integration, resolve interoperability issues simplify healthcare standards and reconcile data which can connect to any healthcare system, abstract the healthcare data formats and functionalities to simple APIs and provides storage user experience and dashboard capabilities to help users act on data