HiPaaS - Microservices based Healthcare Integration Platform

HiPaaS – Microservices based Healthcare Integration Platform

HiPaas is complete Revenue Management and Practice Management application
HiPaaS API has everything you need to enable healthcare integrations for EDI and HL7
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HiPaaS is microservices based Healthcare Integration Platform with EDI and HL7 APIs

Our Customers

We work with wide range of customers – large Hospitals, Healthcare plans, Insurance, Technology, Manufacturing companies and Startups. DevCool team boasts technology innovation expertise along with bulletproof vetting and hiring process.

HiPaaS offers complete Revenue Management & Practice Management microservices solutions

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We are highly appraised by our customers

“The HiPaaS solution was easily implemented and has been a triumph for integration. It is everything we knew put in one place that facilitates deep dive analysis in a more efficient way. This has helped SFHP to reduce the time to market and increased customer satisfaction.” -SFHP CIO

“API were simple to integrate. DevCool HiPaaS did a GREAT job helping the team gain confidence in X12, so that was HUGELY helpful!  We’re confident that you’re more knowledgeable (with real-world X12 practical knowledge)” – WPS IT Architect

“HiPaaS helped us to integrate multiple Clinics using different EHR systems using HL7 in less time and low cost!  With HiPaaS – we’re able to reduce our manual work for processing claims and can add more customers”. – Hippocratics CEO

HiPaaS offers various pre-built healthcare microservices solutions

Eligibility Microservices – Ensure correct eligibility before treatment!

Access real-time healthcare eligibility data via our dashboard or integrate with your application using our API. #1 Real-time Eligibility API for 270/271 . Our Eligibility Service provides Medical and Dental Eligibility data:

  • Get complete set of eligibility data on request
  • Real-time eligibility Rest/Json based API for integration
  • Connected to leading Medical Insurance companies, Medicare HETS/CMS, Medicaid, State exchanges, leading Dental Insurance companies.
  • API is connected to Medicare CMS/ HETS to get Medicare Part A, Part B Eligibility
  • No EDI or healthcare knowledge required.
  • Easy to read and understand response in simplified English.
  • It is used by members across various states to get eligibility data.
  • The response is mapped into simple readable JSON – Easy plugin to your EHR and other applications
  • You can now just call our API to connect to any insurance company, clearing house, Medicare, Medicaid or Medi-Cal plans and get the eligibility.

Co-Pay management – Track your patient payments and match to Claims

Capture Payments and Co-Pay data and align it to Claims.

  • Simple screens to capture payment by patients
  • Reconcile with claims payments
  • Easy reporting of payments
  • Payment integration with Payment service
  • Import reports from external system of payments

Claims Submission – Ensure No claims are left behind

Submit 837 I, P, D to any insurance company using simplified API. Submit Real time or Batch 276/277 with simple JSON API Our Claims connectivity solution provides following functionality:

  • Send or receive standard or custom 837 I, P, D file formats.
  • Eliminate spreadsheet with our simplified dashboard that focuses on errors and edits
  • Simple claims dashboard which focuses on claim file data, pre-processing and load logic.
  • No claims left behind – account for every submitted claim
  • Trend claims submission data quality by trading partner, medical group and provider
  • Trace every claim till it is paid –file statistics, work in progress claims, pending claims, rejected claims.
  • Ensure compliance and audit trail.
  • Receive or generate 277CA files and compare against claims.
  • Real-time and batch 276/277 Claims inquiry transaction and JSON API.

 Claims Status  – Ensure correct Claims status!

Access real-time or batch healthcare claims status data via our dashboard or integrate with your application using our API. #1 Real-time or batch Claims status API for 276/277 . Our Claims Status Service provides status for Claims :

  • Get complete set of Claims status data on request
  • Real-time Claims Status Rest/Json based API for integration
  • Connected to leading Medical Insurance companies, Medicare HETS/CMS, Medicaid, State exchanges, leading Dental Insurance companies.
  • API is connected to Medicare CMS/ HETS to get Medicare Part A, Part B Status
  • No EDI or healthcare knowledge required.
  • Easy to read and understand response in simplified English.
  • It is used by members across various states to get claims status data.
  • The response is mapped into simple readable JSON – Easy plugin to your EHR and other applications

Claims Payment Management – Account for every $ for claim and ERA payments

Claims Payments / ERA connectivity APi Services offers following functionality:

  • Receive standard or custom 835 file formats.
  • Ensure 835 file is balanced against check payments
  • Account for every claim and ERA payment
  • Compare 999 files and identify errors in 835 files
  • Reconcile each payment data for correctness
  • Identify and Fix errors in files and resubmit data

Claims Analytics – Audit and Compliance for every claim

HiPaaS Claims Analytics provides clear end-to-end view of Claims lifecycle. Every Claims 837 file, Paper claims are tracked, compared against EDI, QNXT, Facets. Claims statuses are tracked to provide intake and monthly view. Examiner productivity is tracked. Claim Payments are tracked.

  • Improve Claims reconciliation process
  • Account for every claim and file received. No Claims left behind!
  • Ensure proper access before approving claims
  • Submit Medi-Cal, Medicaid, Medicare Encounter data report
  • Account for every Claim and Encounter received
  • Increase auto adjudication
  • Identify delays in claims Adjudication
  • Identify Claims errors and fix them upfront – pre-processing
  • Hold Claims with specific scenarios
  • Identify and fix repeating claims Pend Scenarios
  • Ensure payment accuracy by matching it to 835 and ERA data
  • Measure Examiner productivity
  • All Data you need for Preventive Care

 834 Enrollments Submission- Ensure access to care at all times!

Our Enrollments and Benefits submission provides following:

  • Send or receive standard or custom 834 file formats.
  • Simplified 834 API and services
  • Simple Enrollments dashboard which focuses on enrollments file data, pre-processing and load logic.
  • No member left behind – account for every submitted member data
  • Eliminate spreadsheet with our simplified dashboard that focuses on errors and edits
  • Ensure all trading partners & providers receive the correct membership data
  • Built-in trending of enrollment quality metrics
  • Ensure compliance and audit trail

Enrollment Analytics – Ensure members have access all times!

Enrollment Analytics compares & reconciles member data with external monthly full file 834 against QNXT membership system. It compares the detailed eligibility data, rates, dual membership. GPS also compares outbound membership that is sent to Providers to match the incoming membership data and PCP selections. The errors are highlighted on simplified BI dashboard.

  • Ensure members can access service at point of service, especially on 1st of the month (Rx is most critical).
  • Automate Monthly Full File Compare
  • Improve FAME Monthly processing time from weeks to few hours
  • Compare 834 data element with Membership data
  • Identify Rate mismatch, Dual coverage mismatch and PCP differences
  • Identify Retro historical changes
  • Ensure all trading partners & providers receive the correct membership data
  • Gather & trend enrollment quality metrics
  • Identify and Fix errors in membership data
  • Ensure compliance and audit trail
  • Identify and Fix technical errors

820 Payments – Balance every 820 $ payment against Eligibility!

Payment connectivity and reconciliation offers following functionality:

  • Send or receive standard or custom 820 file formats.
  • Simplified dashboard that focuses on errors and edits
  • Account for every incoming $ from Medicare/MediCal against outgoing provider payments
  • Reconcile every member data payments against membership data, capitation payment against membership data and outgoing provider payments, compare rates, and dual memberships payments against PCP assignments.
  • Identify Retro historical payments

HL7 Integration using API – Connect to any EHR, EMR

Enable HL7 integrations with any EHR/EMR, PMS, Labs, Pharma, Devices and others with following features

  • Relate HL7 Orders against X12 Claims 837 files
  • Support for HL7 ADT, DFT, ORM, CCDA and others
  • Support for – FHIR (fire)
  • Support for custom HL7, XML and old formats
  • Support for Master Patient Indexing
  • Easy to integrate with JSON based Patient API for various Patient transactions – Add, Change, Remove, Add Insurance, Add appointments, Add Visits, Add Charges, and others
  • Ensure profitability – Calculate value of patient and care
  • Calculate various factors like CPT cost, inventory cost, real estate cost, practitioner cost, referral commission, marketing, admin cost and other ongoing cost – including charge backs.
  • Calculate intangible value of preventive care based on various treatment factors: number of visits, number of procedures, repeat procedure treatments, pharmacy prescriptions, quality of treatment and overall duration of single encounter with Patient, Patient satisfaction and others.
  • Get simple dashboard for value of patient with value by procedure, value by insurance, value by agents/referrals, value by pharmacy, value by provider, value by commissions.

Patient Mobile  – Patient Life Cycle management mobile solution

Enhance your reach to Patients via our Patient app that provides following:

  • Find locations
  • Schedule appointments
  • Push Educational and awareness content
  • Alerts and Notifications to Patients
  • Reminders on appointments and follow ups
  • Pre Insurance questions answered before they come for appointment
  • Collect Co-Pay
  • Enter Insurance data
  • Get Eligibility

Patient 360 – Calculate Value of Patient and Value of Care

Value of Patient is focused on financial profit/loss per patient and preventive care patient satisfaction levels. There is no better way for Clinics/Hospitals to calculate the value, cost & preventive care for clinics than guessing and going thru multiple spreadsheets. Normally, clinics realize the amount of loss after the fact – in few months/quarters. HiPaaS Analytics takes into consideration various factors like CPT Cost, Inventory cost, real estate cost, Practitioner cost, Referral commission, Marketing , admin cost and other ongoing cost – including charge backs. Intangible value of Preventive Care is determined based on various treatment factors: HiPaaS Analytics takes into consideration factors like number of visits, number of procedures, repeat procedure treatments, pharmacy prescriptions, quality of treatment and overall duration of single encounter with Patient, Patient satisfaction and others. The value is further categorized by value of patient, value by Procedure, value by insurance , value by agents/referrals, value by pharmacy, value by provider, value by commissions.

What makes HiPaaS a true microservices based architecture?

  • Enable business functionality via our front end (Web or Mobile) or integrate to our API
  • Microservices based architecture with REST JSON based APIs
  • On- premise solution or on Cloud Pre-built Transformation/Translation mappings
  • Every transaction is stored and maintained – 100% Compliance and audit using built-in automated reconcile logic
  • Simplified interactive dashboard that focuses on errors and issues
  • Workflow driven Trading Partner Management
  • Pre-built connectivity to leading insurance companies (BCBS, Kaiser, Cigna, Anthem, United Healthcare , Aetna, and others), Medicare HETS/CMS, Medicaid, and State exchanges.
  • Integrate to any EHR, EMR or Labs via HL7 API
  • Integrate to any device using our iOT APIs