The HIPAA Enrollment Master

Software Solutions for the 834 HIPAA EDI transaction set

The 834 EDI transaction set is used to transmit enrollment records between plan sponsors (an employer or Medicaid for example) to the insurance company or TPA (Third Party Administrator) to update coverage details. Enrollment records contain demographic information on the insured and the details of their coverage, co-pay, eligibility dates, primary care physicians and anything else related to the coverage and benefits.
The 834 transaction is used increasingly and has replaced a myriad of other formats that were used to transmit enrollment information. Especially State Medicaid enollments are now mostly using this format.
Health Insurance Exchanges (HIX) use the 834 format to transmit enrollment information to the carriers.  The HIPAA Enrollment Master is the ideal solution for the HIX connection. Together with the EDI Exchange module, which takes care of the 999 and TA1 acknowledgement transactions and manages transport and encryption, can the HIPAA Enrollment Master extract the data into a database, there you can do manual edits and then create the reconciliation and effectuation files back to HIX. We are currently testing the HIPAA Enrollment Master with Maryland, DC, Arkansas and Michigan exchanges.

The HIPAA Enrollment Master provides complete control over 834 HIPAA EDI electronic enrollment records.

The most common features are

  • Browsing through an EDI 834 file and viewing each enrollment record as a form. All cryptic codes are translated into their descriptions
  • Print or save enrollment records as image files in PDF or TIFF format
  • Export enrollment records as tab-delimited text files or Microsoft Excel spreadsheets
  • Export the enrollment and benefit data to just about any database system
  • Query and view enrollment data in database
  • Create 834 electronic enrollment files from the database
  • Transparent handling of the 4010 EDI format as well as the new 5010 version.
  • Automate EDI file processing with Window's scheduler
  • Integrate EDI Exchange for complete automation and HIPAA compliance checks

Download a 15-day trial version of the HIPAA 834 Enrollment Master.