AI-enabled EDI validation & functionality

Make Artificial Intelligence a Reality

Simplifying
Healthcare
EDI

EDI Processing, CMS Compliance, FHIR API

Complete Healthcare
EDI functionality:
Claims, Enrollments, Eligibility, Pre-Authorizations, & Payments. 

A fully integrated Healthcare EDI suite

Group 1361 (3)

834 Enrollments Management​ and Full File Compare

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

Claims Management (837) & Claims Payments (835) Reconcile - Revenue Management

Improve the overall intake processing of your claims with out-of-box processes to enable 837 I, P, D EDI Processing
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 Eligibility (270/271) 
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)

Inbound Encounters:
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

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

Make real-time decisions with EDI data

Build with EDI transparency and auto corrections in mind.
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
$ 3999 Monthly Per Transaction
  • L1/L2 Validation
  • L3-L7 Validation
  • Data Load & QNXT Load
  • Front End Data View
  • Unlimited Volume
  • Access Via API

HiPaaS CMS Interop

FHIR Repository
$ 4999 Monthly Per Transaction
  • USCore Resources
  • Da Vinci - Carin, Plan mappings
  • Data Load and Mapping
  • Oauth, Consent Mgmt
  • Unlimited Volume
Popular

HiPaaS

HL7 Streaming
$ 4999 Monthly
  • All HL7 Transaction
  • Loaded in Database
  • Front End View
  • Access Via API or Kafka
  • Unlimited Volume

HiPaaS

Enterprise
Call Us Monthly Per Transaction
  • L1/L2 Validation
  • L3-L7 Validation
  • Data Load & QNXT Load
  • User Experience
  • Unlimited Volume

HiPaaS Platform Features

Never Worry About Data Complexities

Store, locate, and reconcile healthcare data as it arrives using Graph DB

Stream Healthcare Data in Real-time

With HiPaaS Kafka stream large volumes of data in real time.

Healthcare Interoperability Solved

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

Autoscale Healthcare Infrastructure

Autoscale with Kubernetes Cluster management and Docker containers.

Case Studies

Healthcare Insurance

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

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