The HIPAA Claim Payment Master
Software for the 835 HIPAA Electronic Remittance Advice
The HIPAA Claim Payment Master:
- Converts 835 EDI files into printable forms and displays Explanation of Benefit information on screen and paper
- Displays all the payment ande adjustment information that is contained in the EDI file
- Translates all cryptic codes into their descriptions.
- Creates an image file of a claim payment for a document management system.
- Exports claim remittance data to any database with a schema and scripts provided for MS SQL Server and MySQL and Oracle.
- Recreates the image forms from database.
- Creates 835 EDI files from database regardless of how the information got there.
- Integration with EDI Exchange and automation
Probably the most important HIPAA transaction set after the 837 claims is the 835 Electronic Remittance Advice. This transaction set contains the adjudication information and lists payments and adjustments on a claim. That's why it is also called electronic EOB (Explanation or Benefits) or EOP (Explanation of Payment). The HIPAA law prescribes the 835 transaction set to be used to inform providers how and how much they were paid for a claim. Adjudication information can get quite complex with adjustments being made on the claim level or on the service line level, with service lines possibly bundled or unbundled, and often with other insurances involved and with complex COB (Coordination of Benefits) payments and adjustments. The raw EDI file is completely un-intelligible to most people.
Many providers who are capable of producing electronic claims and EDI 837 files or who go through a clearing house to submit claims in electronic format are not yet equipped to integrate the electronic payment advice (835) into their accounting system. They need a way to display the information contained in the electronic payment record, so that they can enter the payment information into their system. The HIPAA Claim Payment Master is the tool to do this.
Equally, a healthcare provider with a capable IT staff can use the HIPAA Claim Payment Master to write the data in the 835 files to a database schema that we provide. These staging tables contain all the available information in the 835 transaction set. Once the data is loaded into the database one can recreate the image from the data record or one can write programs and routines to extract the data and for example update the accounting system from those staging tables.
Finally, there are payers who need to produce an 835 EDI file from their system to inform providers about their payments. They can export the claim payment and adjudication information from their system into the HIPAA Claim Payment Master's staging tables. The HIPAA Claim Payment Master then can create the 835 file in all its complexity and combined with the EDI Exchange module can transmit the file to the provider or clearing house securely. This way a payer can work within the system that they are familiar with while easily fullfulling the need to create electronic payment advice files.