For workers in the health insurance industry, the Health Insurance Portability and Accountability Act (HIPAA) makes for daily — even hourly — complications. The need to automate HIPAA data processes is a no-brainer, but that doesn’t mean it’s easy. The challenge comes down to integration, and difficulties include the management of inbound and outbound data feeds between insurance companies and healthcare providers, the connections to backend EMR/EHR systems for patient updates, and the need for a web-based platform in the form of dashboards for providers and carriers to resolve issues related to patient data or out-of-sequence policy changes.
In order for you to automate and process HIPAA messages quickly and easily, you need a B2B Integration Solution that provides comprehensive HIPAA processing functionality. Here are the two most important aspects that make all the difference:
Relying on programmers is costly, inefficient, and unnecessary. With a browser-based solution that has a visually rich user interface, non-technical business users can easily setup trading partner data files (enrollments, claims etc) and map the data with custom fields included in the client file. This can be achieved through a graphical mapper capability, and should also allow for the mapping of HIPAA data such as 837 Claims or 834 Enrollments to backend systems. Another important feature are flattened EDI X12 schemas which minimize the complexities of traversing through loops and allows easier mapping of data to target applications.
Your integration solution will need a B2B Trading Partner portal that provides quick and easy setup of new providers and payers, as well as an SOA framework that allows for reusable maps, routing rules and trading partner configurations. It should also have a workflow that enables business users to perform holds, reconciliations and resubmissions of HIPAA data back into applications. A solution that includes data mapping software capabilities and pre-built functions and templates is essential and will enrich data access through lookups, value-maps, conditions, filters, and sorting. Make sure, as well, that the solution you’re looking at fully supports all HIPAA versions, and that it can provide automatic notifications of 997 or 999 acknowledgments.
Wasting time and money tracking and correcting data reconciliation issues is something you need to do away with immediately. Figuring out whether or not a message was received should be easy and efficient, and a solution with a visually rich dashboard for business users will reduce time and effort by making it easy to check statuses on all HIPAA transactions. If data is incomplete or lacking necessary documents to process a request, business users should be able to easily reconcile the message with policy information in a carrier’s master database. In order to achieve this, you need the ability to easily track and monitor the status of data feeds through interchange, transactions, partners, and other business data fields.
For most companies that have tedious manual processes in place, automated workflows fully integrated with data repositories is an absolute game-changer. You should look for a solution that allows for the configuration of real-time or batch triggers in order to push or pull HIPAA data to and from trading partners or internal systems as well as one that will easily validate all HIPAA inbound and outbound data for specific versions and business rules regarding data conversion, errors or partial data feeds. Your solution should also give automatic alerts and notifications in case of data or routing errors, and it should be able to easily resend a previously failed transmission to a trading partner.
As a side note, you also need to think seriously about an integration platform that will provide you with the ability to scale as the number of trading partners, applications, users and the rules governing data change over time.
When it comes to HIPAA integration, it’s the fine print that counts. These life hacks will save you a lot of effort and energy, and they may even save you from making a critical error in choosing the wrong Integration solution. We have no doubt you’ll thank us later. Or now is fine, too…
Check out the following reference links for more information:
Processing of HIPAA 837P With Adeptia's B2B Solution
Processing of HIPAA 835 With Adeptia's B2B Solution
Mapping of HIPAA 270 With Adeptia's B2B Solution