Introduction

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The whole idea of EDI is ability of disparate computers to communicate without the involvement of human being. So while the manual answering of claim status requests is possible, there are certainly limitation on how many request a case worker can handle per shift. And with the introduction of the Affordable Care Act it is now necessary for payers to implement real time interfaces to allow providers instantaneously with responses to their claim status and eligibility requests.

 

So the real challenge is to connect the HIPAA Claim Status Responder with the back end system and get access to the live data.

 

The HIPAA Claim Status Responder has a database interface that allows one to

export the request data in an SQL compliant database such as Microsoft SQL Server, mySQL, Access or Oracle. The data is placed in two hierarchical tables, EDI_ClaimStatusHeader and EDI_ClaimStatusDetail.
Write the response given to the request record
Search in claim tables for the status of a particular claim
encapsule the claim status into a 277 file.

 

There are scripts provided and a screen to generate those tables for a few important databases such as Microsoft SQL Server, the open-source database mySQL and Oracle.