The HIPAA Eligibility Responder

HIPAA IT Software Solutions for the 270/271 transaction sets. Now completely reworked and rewritten in Microsoft .Net architecture, 5010 compliant and now with database integration

The HIPAA Eligibility Responder is for organisations that need to respond to 270 eligibility requests. The software parses the information that is contained in an X12 270 EDI Eligibility Request file and allows to enter the appropriate eligibility information manually. It then packages the benefit eligibility information into an X12 271 EDI Eligibility Response file.

Furthermore, the HIPAA Eligibility Responder exports the EDI data into any ODBC/SQL compliant database, such as Microsoft SQL server, Oracle, mySQL. A data structure is provided to serve the eligibility information so that the software creates the 271 automatically. It will be the responsibility of the user of this software to supply this interface with data. We provide assistance and consulting services if needed.

This software is designed to enable HIPAA compliance in regard to the 270/271 transaction sets without a big investment. The manual response mode is aimed at organizations that do not expect a large volume of electronic eligibility requests but want to be in compliance with federal regulations while the database interface automates the process of generating electronic eligibility responses.

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

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

The HIPAA Eligibility Responder will enable you to:

• Display the eligibility request information on screen.
• EDI code sets are translated into their descriptions to show the transactions clearly and understandably.
• Choose from drop down menus the appropriate code sets and avoid data entry mistakes.
• Return a simple answer, the HIPAA minimum requirement or add the complete spectrum of information that the 277 transaction set allows
• Package multiple eligibility 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 code sets, so you will have to choose only from a subset of the hundreds of codes that HIPAA provides.
• Export the request data to any ODBC/SQL compliant database
• Create the 271 response file if eligibility data is provided through a data interface

Here some screen shots:

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)