Make Artificial Intelligence Real
Simplifying Healthcare EDI​

We help you rethink Healthcare solutions
Medicare, Medicaid and Marketplace across 18 states
Processing 10M+ Claims, Enrollments, Eligibility and Claims payment
Hospital Remittance & Revenue Management
Reconciling 20M Claims 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


Why Choose HiPaaS?

We envision HiPaaS to focus on improving patient and revenue outcomes by implementing AI driven use cases.

Sandeep Deokule

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