A healthcare provider sends 278 transaction to request an authorization from a payer. The hospital is asking the insurance company to review proposed healthcare services to be provided to a given patient, in order to obtain an authorization for these services.
HiPaaS EDI enables EDI 278 Prior authorization transaction for both, Payers and Providers.
HiPaaS EDIVal Prior Auth Workflow
For Insurance Companies
We enable 278 Prior Authorization transactions for Payers to receive data , define workflow, validate edi document, track responses, link to claims and load in destination system
Receive 278 Prior Authorization Transactions from Providers - Real time and Batch Receive 278 Prior Authorization Transactions via EDI and security. Route the request to membership system using intelligent router. Get and generate the response.
999, TA1 Response Create and send 999, TA1 based on SNIP L1 / L2 Validation results based on the Companion guide configuration. Outgoing 999 is attached to Graph Node and available to audit
Track and Send Responses Track all requests and send responses, follow up with providers and internal staff
Link Claims and Prior Auth Link attachments to Claims and any other case management systems.
Prebuilt mappings - QNXT, Facets , Pega and Healthedge Prebuilt mappings, connectors and integration to QNXT, Facets and healthedge systems
View Prior AuthorizationTransactions via EDI Requests and Response time View incoming requests and outgoing responses, track response time , track AAA, Track compliance.
We enable 278 Prior Authorization transactions for Providers to send Prior authorization , make sure they are validate documents and track responses
HiPaaS RCM or API to send 278 Prior Authorization Use out HiPaaS RCM product to send 278 Prior Authorization to clearing house or payers. API is also available to send it directly from EHR system.
Create EDI, Validate and Send to Clearing House We create the EDI , Validate it and send it clearing house or payers. Track responses and 999 from Payers. Track the attachment and claims status till claim is paid.
Tracking available via Web or API End to end tracking of responses available via HiPaaS RCM web or API.
Prior Authorization Transaction API Same Prior Auth data for other member touch points like web, provider portal, member portals, IVR and customer service port
Prior Authorization on Kafka Stream Responses on Kafka streams
Views and Alerts Setup different business threshold alerts and notify business. Define analysis views by Provider, by trading partner, Submitter and others.