The HIPAA Claim Status Responder

HIPAA IT Software Solutions for the 276/277 transaction sets.          Now 5010 compliant!

The HIPAA Claim Status Responder parses the information that is contained in an X12 276 EDI Claim Status Request file and allows you to enter the appropriate status manually. It then packages the status information into a X12 277 EDI Claim Status Response file.The manual mode of this software is designed to give HIPAA compliance in regard to the 276/277 transaction sets without a big investment and suffices for organizations that do not expect a large volume of electronic Claim Status requests.

In addition, the HIPAA Claim Status Responder can export the request information to a database. All the information is stored and the request can be reconstructed and viewed from the database record. It is now relatively easy to build an interface beween your existing database which contains claim adjudication information and the HIPAA Claim Status Responder so the the responses can be created automatilcally. We will be availalbe to consult with the interface construction.

The HIPAA Claim Status Respnder processes files in 4010 and 5010 formats transparently. If a request comes in Version 5010, the response will be in 5010 formation while 4010 requests will be answered with 4010 responses.

Download a 15-day trial version of the HIPAA Claim Status Responder.

Download the detailed help documentation for HIPAA Claim Status Responder. - Acrobat PDF

Watch a Demo

The HIPAA Claim Status Responder will enable you to:

• Display the claim status request information on screen.
• EDI code sets are translated into their descriptions to show the transaction clearly and understandably.
• Choose from drop down menus the appropriate status category and status code.
• Return a simple answer or fill in all the spectrum of information that the 277 transaction set allows
• Package multiple claim status responses into one file
• Set a default status response that gets filled in, if you don't create a specific answer, like "Claim not Found" or "No further information available"
• Edit the status codes and categories, so you will have to choose only from a subset of the hundreds of codes that HIPAA provides.

Fig1 shows the HIPAA Claim Status Responder with three requests listed . (Click to enlarge)

Each individual request can then be called up and answered. The status information and any other codes can be selected from a drop down box, so there is no possibility to enter wrong codes. THe picture below shows a claim status request that has only claim level information. The status information has been filled in.

Fig2: Answering an individual request .(Click to enlarge)

The 277 response file can be displayed in a printable report for easy understanding. This report can also be printed and used as an EOP.

Fig2: Answering an individual request .(Click to enlarge)

Claim status request in formation can be exported to any ODBC aware database such as SQL server, Oracle and mySQL. Two tables, header and detail are used for this purpose. The following pictures shows the configuration screen for the database.