About HIPAA Claim Master

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The HIPAA Claim Master is an advanced tool for healthcare electronic claims.

The HIPAA act of 1995 mandates that every medical claim that is transmitted electronically conforms to strict standards. These standards are developed by ANSI, the American National Standards Institute, under the umbrella of the X12 committee for Electronic Data Interchange (EDI). X12 contains standards for hundreds of electronic data interchanges. Medical claims are contained in the 837-transaction set. X12 standards are continuously developing. The HIPAA compliant versions are version 4010A1 and 5010. The HIPAA Claim Master supports both versions.

 

There are four different flavors of the 837 transactions:

1.The institutional claim format                004010X096A1 and 005010X223A1
2.The professional claim format                004010X098A1 and 005010X222A1
3.The dental claim format                        004010X097A1 and 005010X224A1
4.The reporting claim format                005010X225A2

The HIPAA Claim Master handles all four of them.

Electronic claims were introduced in the 1990's and made mandatory by 1/1/2003. During the last decade, the adaptation of this electronic format was phenomenal. More than 90% of claims are now (2012) transmitted electronically. The HIPAA Claim Master was first developed in 2001 and has undergone tremendous change over those years. In 2011, a new version 4.0 was released based on Microsoft's .Net infrastructure.

The HIPAA Claim Master reads X12 837 EDI claim files and parses the claim information with its built-in EDI translator into distinct claims. Each claim can then be rendered as an image of a UB04, CMS-1500 and ADA 2006 form or the older formats UB92, HCFA-1500 or ADA2000.These images can be viewed on the screen, printed to paper or turned into image files, PDF and TIFF formats, and added into an image management system.

In addition, the HIPAA Claim Master can export claim data to any database. Claim tables can be created within any ODBC/OleDB compliant database such as a Microsoft SQL Server, Oracle or MYSQL. The claim data is then accessible to your own applications plus you can search this data warehouse and even recreate the image.

 

What is an EDI file?

X12 is an ASCII standard. This means that all the content of a transmission consists of ASCII characters. ASCII or text files can be viewed and edited with a regular text editor but since EDI does not use line feeds and carriage returns to mark the end of a line, an EDI document is usually very hard to view.

preview
A view of raw EDI data

As you can see in the previous figure, it is quite difficult to discern the individual data elements within the ASCII text file. One needs an EDI Editor to get a more meaningful representation of an EDI file. The HIPAA Claim Master has a built-in EDI Editor. Here is how this file is displayed in it:

edi-editor
The same data viewed with HIPAA Claim Master's built-in EDI Editor

When you view this ASCII data with a special EDI editor, the individual data segments are visible but it is still difficult to understand the content of the form. EDI tries to abbreviate complex descriptions into short codes; and without a translator only true experts know what this means. This is where the HIPAA Claim Master is indispensable. Its built-in translator parses the significant data elements from the EDI file and prints the data into the well-accepted medical forms HCFA-1500 and UB92 as well as the ADA dental forms. The program's output can be screen, paper or image file (TIFF and PDF) as well as data rows in external tables.