HIPAA Claim Pro

Process Medical Claims with HIPAA Claim Pro

The Claims Module of HIPAAsuite

The HIPAA Claim Pro builds on top of the HIPAA Claim Printer and greatly expands on its capabilities.

In addition to imaging and exporting claims to any ODBC database the HIPAA Claim Pro allows you total claim management from receiving to adjudicating and even paying of claims. This module handles all three 837 transactions, the 276/277 Claim Status transactions and the 835 Payment Advice transaction.

You can send claims to a repricing organization and the HIPAA Claim Pro will update upon return the claim information with the repriced amounts

HIPAA Claim Pro can export claim information into any other existing database through ODBC/OleDB or XML. It can import adjudication data back into its claim database through XML and create automatically 835 transaction sets. This bi-directional data exchange capability allows HIPAAsuite to be the ideal front-end for any existing claim adjudication system. HIPAAsuite keeps track of all the information in the 837 while only the necessary data are exported into the adjudication system, and can then create 835s, 277s or even 837s from its database.

The HIPAA Claim Pro can recreate 837 transaction from its database. This feature can be used by repricing organizations, who add information to the claim and need to send it back to a payer or for a payer-to-payer COB communication.

Download the detailed manual for HIPAA Claim Pro. - Acrobat PDF

By implementing the HIPAA Claim Pro, you will get:

1. X12 837 EDI files that are parsed, with the data in the EDI files saved in an operational data store.
2. Each of thousands of possible data elements captured in a database object.
3. Adjudication, Payment and Claim Status Transactions, that are all perfomed within this database
4. Code libraries with drop-down menus to make sure that you use only HIPAA compliant codes
5. Payment multiple claims in one transaction
6. Retrieval methods to get back claims by a vast variety of query parameters
7. Screens to adjudicate the claims on a claim and line level with HIPAA compliant code sets, status codes and remark codes.
8. Prior payments, by subscriber or other payers, displayed and calculated into the benefit.
9. Ability to view claims by reproducing the HCFA-1500 or UB92 form with a simple click on the View button
10. Automatic Transmission of your EDI files to your Trading Partners by pre-defined methods

Fig1 Retrieving Claims from the database by building complex queries (Click to enlarge).

Fig2 Selecting Claims from the database (Click to enlarge).

Fig3 shows the Adjudication screen. (Click to enlarge).

Fig. 4 Make Claim Line Adjustments with HIPAA compliant code sets through drop down menus

Fig.5 Paying all the adjudicated and open claims to a billing provider. (Click to enlarge). You can deselect claims for a later payment

Fig. 6 The 835 remittance advice that was created with the HIPAA Claim Pro. (Click to enlarge).

Fig 7. The XML configuration utility. Just check the data elements that you need. (Click to enlarge)