Healthcare
Streamline your healthcare transactions
The B2B Data Exchange HIPAA Accelerator is a powerful tool that can be used to receive HIPAA X12 messages (inbound) and validate them using HIPAA Level 1 and 2 validations. Once the messages are validated, they are parsed into Informatica canonical xml format. This allows for easy integration with other systems and makes it possible to automate many of the processes that would otherwise need to be done manually.
In addition to receiving HIPAA X12 messages, the B2B Data Exchange HIPAA Accelerator can also be used to send HIPAA X12 messages (outbound). This is accomplished by serializing the messages from the canonical structure to the HIPAA X12 format. This ensures that the messages are properly formatted and can be easily understood by the receiving system.
Triade’s solution for Claims Inbound and Outbound Processing and X12 EDI/HIPAA Gateway is a powerful and flexible tool that can help:
- Allows Healthcare Payers and Providers to streamline their business-to-business integration processes.
- Reduces implementation efforts.
- Validates, parses, and sends HIPAA X12 messages.
- Connects to Regional Exchanges, or to the Federally-Facilitated Marketplace (FFM).
- Integrates with diverse providers or with health care plan customers or employers.
Clinical HL7 v2/CDA and FHIR Data Conversion
We specialize in converting clinical data from HL7 v2 and CDA formats to FHIR, ensuring seamless integration and compatibility with modern healthcare systems.
- We process data from and to HL7 v2, v3 and CDA Formats
- We process that from and to FHIR and create FHIR hubs for your clients to access data as digitally on demand as required.
Claims Inbound and Outbound Processing – X12 EDI/HIPAA Gateway
Triade’s solution for Claims Inbound and Outbound Processing and X12 EDI/HIPAA Gateway is a comprehensive B2B Data Exchange Accelerator designed to address common business-to-business integration use cases for healthcare. This solution is specifically tailored for Healthcare Payers and Providers that:
- Need to connect to Regional Exchanges, or to the Federally-Facilitated Marketplace (FFM)
- Need a HIPAA Message Gateway to integrate with their providers or with health care plan customers or employers.
Eligibility and Benefits Enrollment
Our team is experienced in EDI X12 and custom eligibility formats, and can assist and guide you to comply with eligibility criteria, benefits enrollment in organization. We have a solution to allow rapid onboarding of your customer files to speed up and streamline the entire process, with the flexibility you need to implement:
- Different layouts
- Customer field logic
- Split/merge logic of files
- Filtering conditions
- Custom schedule
- Custom notifications rules, securely connected via MFT through a robust network solution providing visibility to your internal and external teams whenever you want including self onboarding and self monitoring capabilities.
Data Integration and Management
We offer a wide range of data integration and management services, including data analytics, data governance and master data management. Our solutions are designed to help healthcare organizations to make sense of their data and support data-driven decisions.
Real-time Integration services CAQH CORE compliance
Our B2B healthcare focused integration services includes the X12, Xml and Json formats for EDI 270 <> 271 eligibility and benefits verification for patients, ensuring that their coverage is up to date and that they are able to access the care they need, as well as the EDI 276 <> 277 claims status verification of claims for institutional providers, such as hospitals, care facilities or agents, and for professional providers, such as doctors and dentists.
Why Work with Triade?
We have a team of experienced professionals who are familiar with the complexities of the healthcare industry. Our X12 HIPAA Gateway has been tested and proven to accurately process and validate HIPAA-compliant messages, snip level 1-2 natively and can be extended beyond that. Additionally, our solutions are designed to improve data compatibility and streamline operations for our clients.
- HL7 v2/CDA and FHIR conversion
- X12 837 claims inbound and outbound processing
- X12 834 eligibility and benefits enrollment
- X12 EDI/HIPAA Gateways for B2B data exchange
- Offer data integration and management services to improve operations
- Triade holds a diverse range of certifications and expertise across multiple vendors, global associations, and standard institute including ASCX12, ACORD, HIPAA, and others.
Deep Dive: transaction sets and messages supported
The current version supported by the out of the box HIPAA Gateway Accelerator supports the following HIPAA EDI transaction sets (version 5010A) for both Inbound and Outbound traffic, it can be extended as needed or be customized to include more messages. Here’s a list of high level messages and their explanations:
Eligibility, Coverage, or Benefit Inquiry
EDI 270 and EDI 271 allow healthcare providers to inquire and receive responses about a patient’s coverage and benefits information with their health plan. This includes information such as plan type, coverage dates, deductibles, and co-payments.
Claim Status
EDI 276 and EDI 277: allow healthcare providers to inquire and receive responses about the status of a previously submitted claim. This includes information such as whether the claim has been received, processed, or denied.
Referral Certification and Authorization
EDI 278 allows healthcare providers to request pre-authorization or certification for certain medical procedures or services. This includes information such as the reason for the request, the proposed treatment, and the patient’s diagnosis.
Payment Order/Remittance Advice
EDI 820 and EDI 824 are used to send electronic payment information and acknowledge the receipt of transactions, including check or electronic funds transfer (EFT) information, and remittance information to providers.
Benefit Enrollment and Maintenance
EDI 834 is used to transmit information related to enrollment and maintenance of health plan coverage. This includes information such as the enrollment or disenrollment of a member, changes in coverage, and updates to dependent information.
Health Care Claim Payment/Advice
EDI 835 and EDI 837 are used to submit claims to payers and send payment information for claims that have been processed. This includes information such as the amount of the payment, the reason for the payment, and any adjustments that have been made to the claim.
Implementation and Transaction Set Acknowledgment
EDI 999 and TA1 Processing are used to process and acknowledge the receipt of a transaction set and to provide information on the status of the transaction.
Additionally, Triade’s Clinical Solutions and Claims Inbound/Outbound Processing Solutions are designed to provide end-to-end management of crucial data, tracking process and streamlining claims submitted to payers. These solutions are built to help organizations stay competitive and manage their processes more effectively. Here are some insights:
Clinical Solutions
Clinical solutions are technology-based systems that support the delivery of healthcare services. These can include electronic health records (EHRs), practice management systems, and clinical decision support systems. These solutions help healthcare providers manage patient data, track patient progress, and improve the overall quality of care. We support and build integration systems from and to EHR’s.
Claims Inbound/Outbound Solutions
Claims inbound solutions are technology-based systems that support the receipt, validation, and processing of claims submitted to payers. These can include claims management systems, claims editing systems. We support and build integration systems from and to Claims inbound and integrate them with external partners with purpose built solutions for healthcare integration.
