The HIPAA270/271 Eligibility Pro is HIPAAsuite's tool that handles X12 270 Eligibility and Benefit requests.
It has two modes: Manual and Automatic
In manual mode the HIPAA Eligibility Pro displays the request information in a form and allows the creation of an X12 271 Eligibility Response by filling the response information through several screens. The request information can also stored in an operational data store.
In automatic mode, the complete eligibility information of all members of a health plan gets loaded into HIPAAsuite's database through a flat file. When a 270 EDI request comes in, the program searches for the member and either returns the member's eligibility information in an 271 transaction set or in case that the members is not found or too many matches are found a 271 with that message will be returned. In automatic mode, no user intervention is needed; the HIPAA Eligibility Pro works as an appliance in the background.
 Download the detailed help documentation for HIPAA Eligibility Pro. - Acrobat PDF
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By implementing the HIPAA 270/271 Eligibility Pro, you will increase productivity through the following features:
- Ability to receive and process 270 benefit eligibility transactions and to be able to create X12 271 Eligibility Response files.
- Build-in translation engine extracts the information in an X12 270 Eligibility Request and stores that information in a database.
- Requests can be fully automated if you load your membership file with the eligibility information into HIPAAsuite's database.
- In manual mode Requests are displayed in a screen like the one displayed below:
Fig1 Displaying a X12 270 Eligibility and Benefit Request (Click to enlarge)
- Ability to create a full response for the HIPAA compliant code sets, as seen below:
Fig2 shows the 271 Response screen. (Click to enlarge)
- Additional entity information like the PCP etc. can be added and the X12 271 is created.
Fig. 3 Information on a PCP, added to the 271
- EDI viewer that allows you to view the content of the EDI file color coded and with each segment on a new line, which is helpful in viewing raw EDI data segments to debug or fine tune the processing of EDI.
Fig. 4 The 271 Eligibility and Benefit response that was created with the HIPAA Eligibility Pro. (Click to enlarge)
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