Achieve EDI Modernization using HiPaaS
Healthcare EDI Modernization can now be flexible, light weight with next generation API based model. HiPaaS is a next generation healthcare EDI integration platform with micro services an APIs. HiPaaS provides all EDI transactions and trading partner management with pre-integrated business processes around existing Facets, QNXT, Medicare/CMS, Epic and legacy systems.
HiPaaS EDI Solution
Implement any EDI/X12 transaction across payers, providers and clearing houses. Implement 834, 837, 820, 835, 27x, 274 transactions. Reconcile multiple sources of Healthcare data (Files, QNXT, Facets, EHR’s) with CMS, Medicare, Exchanges, State, and providers.
Complete EDI 837 Claims and Encounter Management Solution
Generate, Validate, Send, Receive, Reconcile 837 claims
837 Transaction Tracking
Track every file, claim and line item on out dashboard. Streamline Trading Partner setup.
Generate 837 I, P, D files from your local EHR application, database or salesforce. 837 Generation REST API
837 SNIP L1-L7 Validation
Validate 837 against SNIP L1-L7 before sending or loading. Validate Medicare, Medicaid, State codes. Increase AUTO Adjudication rate. Inbuilt calls to check Provider NPI, Member validation
837 Claims Edit or Manual Submission
HiPaaS offers mechanisms to route and automate claims edits. Simple screens are provided to edit the claims and then either resubmit. Interface to submit manual claim also available.
837 Claims and 835 Payments Reconcile
Make sure no claim left behind. Reconcile claims with payments and ERA. 30/60/90 days A/R report. Fix claims and resubmit. Generate 835 file or load 835 to reconcile.
Encounter Data submission
Generate, Validate and Send Encounters to state or Medicare. SNIP L1-L7 validation before sending to reduce rejections.
Claims Analytics Dashboard
Dashboard to provide claims work in progress view, daily rejection, pending view, examiner productivity view. Denial reasons and analysis. Technical and data errors views
Send or receive 835 data. Generate 835 or load 835 in hipaas DB, Validate 835, Map 835 data to claims for payments.
Load 277CA and map it to claims for rejections. Generate 277CA based on claims validations. View on dashboard 277CA accepted and rejected claims data and reasons. Fix claims and resubmit.
Complete EDI 834 Enrollment and Benefit Management Solution
Generate, Validate, Send, Receive, Reconcile 834 Enrollments. Handle custom formats.
834 Enrollments Clearing House
834 Clearing house - Send 834 to multiple payers (Kaiser, BSC, UHC, Aetna, Regence, etc.)
834 Tracking and Benefit Management
Simplified dashboard and interface to track enrollment files, data and trading partners. Integrate paper enrollments. Eliminate spreadsheet with our simplified dashboard that focuses on errors and edits
834 File Generation
Generate 834 files from your local applications based on payer companion guides
834 Load and Compare
Compare against existing enrollment in QNXT, Facets and generate delta 834 files
834 Full File Compare
State/CMS full file 834 compare with QNXT data. Differences are published on simple dashboard. Compare Rate Code delta, Medi-Medi Delta
820 Cap Payment file Load and Compare
Compare State/CMS 820 Cap payments with QNXT eligibility, payment data. CFO dashboard included. Account for every incoming $ from against outgoing provider payments
CORE Real Time Transaction API - 270/271 & 276/277
Handle Real time transactions using Rest API - Eligibility, Claims Status and more...
270/271 Eligibility Medicare API
Real time eligibility integrated to Medicare HETS Web service. Our Eligibility Service provides Medical and Dental Eligibility data in simplified Json format.
270/271 Eligibility for Facets/QNXT
Get realtime eligibility from Facets or QNXT. CORE compliant
276/277 Claims Status
Get real time or batch claims status from Facets, Mainframe or CMS.
HiPaaS is HIPAA compliant
It is cloud based, light weight, agile platform that can be running in days
Reduction of time and costs through ready to use process libraries and APIs
Saving of customer efforts with end-to-end managed services at affordable costs
High level of support and responsiveness to help solve business problems
Easy choice of offerings that can be deployed through a plug-and-play model