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
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.
Claims Management (837) & Clams 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
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
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
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.
SNIP L1-L7 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 model support
End to End
EDI Reconcile
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.
837 Claims Management
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
277CA transaction response
999, TA1 Responses
276/277 Claim
Status
Real and Batch Claims Status (276/277)
Ability to Support real-time or batch processing
Send/Receive 276/277 transactions
Real-time 27X API's for Insurance, Medicare, Medical and Dental providers and trading partners
CAQH CORE Compliant
835 Payments
Management
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 Payments
Reconcile
820 Premium Payments:
Load current and historical premium payment files
Reconcile file and payment level metrics
Rate Code Validation
Reconcile 834 to 820 payments
834 Enrollments
Management
Business workflow UI to pre-scrub and validate prior to loading into membership system
834 Enrollment Intake & Submission Daily Files
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
834 Enrollments Full Reconcile
834 Enrollment Intake & Submission 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
270/271 Eligibility Service
Real and Batch Eligibility (270/271)
Real-time 27X API's for Insurance, Medicare, Medical and Dental providers and trading partners
CAQH CORE Compliant
275 Attachments
275 with Attachments Intake
Additional information claim responses (277RFAI)
Attachments loaded in viewer system related to Claims - Claims Viewer
278 Pre Auth
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
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
837 Encounter Management (I)
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
837 Encounter Management (O)
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
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