API Driven EDI

End to End Healthcare EDI Transactions – Claims, Enrollments, Eligibility, and Payments for Medicare, Medicaid and Marketplace. (837, 834, 276, 270, 835, 820, 278, 274)

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

Group 249

End to End EDI Reconcile

HiPaaS enables 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.

Group 1361

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

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276/277 Claims 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

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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 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

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

Architecture of Future

Lead with HiPaaS

Built with future in mind - Digital, Cloud Computing, On Premise, Graph Data, Containers, Kubernetes and more

Data Lake

Case Studies - Healthcare Insurance

HiPaaS Enrollment AI

The best candidate in the healthcare x12 transaction set that could benefit the most from Artificial Intelligence is the 834 enrollment and benefits transaction. The

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Case Studies - Hospitals

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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