HIPAA Authorizer

Providing healthcare services and finding out they are not covered or authorized is a major headache to providers. The handling of prior authorizations is a major burden on payers and providers. The potential for savings are huge by going electronic and will change the way we manage prior-authorizations and pre-approvals. The 278 EDI transaction set is used for authorization requests and services review.

It will raise the quality of the healthcare in the following ways:

• Avoid delays in treatments
• Reduce prescription abandonment
• Save on the processing of prior authorizations
• Eliminate unpaid services
• Increase patient satisfaction

Our HIPAA Authorizer is the best tool for payers and for providers to handle prior-authorizations electronically.

For providers our HIPAA Authorizer handles prior-authorizations. Enter requests, send them to the payer and see the responses. With our HIPAA Authorizer you can:

• Enter authorization requests fast and easy
• Send 278 requests immediately or in batch mode to payers
• Receive and process 278 responses
• Support real-time CORE Phase III
• Automate 278 requests and responses
• Tie-in your existing IT system and processes

Utilization Management Organizations (UMO) will save the insurance companies money by managing diseases more efficiently, while helping patients. Receive electronic authorization requests from a provider, understand and adjudicate the requests, send the 278 responses back to providers or pass them on to payers.

For Payers the HIPAA Authorizer can receive requests from providers, UMO’s or clearing houses. Deny or approve authorizations through a software interface or manually. Create 278 EDI responses and send to providers.

For Payers and UMO - Payers and Utilization management organizations (UMO) can save billions and improve their subscribers medical services by using electronic authorizations. Everyone knows in the healthcare industry that prior-authorizations are a high cost factor. The only way to improve things, is to make the process electronic and use the 278 transaction set required by HIPAA.

We created a solution and it is the HIPAA Authorizer software. It allows payers to improve their bottom line and discover the savings of going electronic with prior-authorizations. Be a leader in the industry and comply with the new CORE Phase IV requirements to improve business.

With our HIPAA Authorizer you can:

• Receives 278 requests
• Displays request on screen in manual mode
• Allows you to adjudicate and send responses
• Supports multiple databases
• Stores requests and responses
• Ties in with your existing IT system and processes
• Supports real-time transactions with our HIPAA RealTime Server

Participate in the savings with our HIPAA Authorizer. Download the free trial today! >

DB Connect feature allows HIPAA Authorizer to export 278 EDI authorization request records into any ODBC compliant database.

HIPAAsuite supports the following databases:

• Microsoft SQL Server
• Microsoft SQL Server Integrated Security
• Oracle
• MySQL
• IBM DB2
• Advantage
• Any other ODBC compliant database

The HIPAA Authorizer uses two tables, EDI_AuthorizerHeader and EDI_AuthorizerDetails, into which the 278 data are exported.

These tables can also serve as staging tables for the integration with your own system. We recommend that you establish these two tables and process from these staging tables the data into your system and apply your business rules. Once you have the data in a format that is legible to your specific system and experts, you can easily work from those tables.

Many payers and providers invested in image scanning system for their paper claims and often business processes rely on people being able to access the image of a submitted claim from an image store. With electronic claims this process breaks unless you use the HIPAA Authorizer’s image file creation feature.

There are two image file formats to choose from, TIFF and PDF. The image of the claim as you see it on screen can be saved in those formats, including additional pages and detailed COB information. The PDF images are searchable and indexable, meaning there is some basic information of the claim saved in the file in meta data spaces that help with indexing and sorting the images.

You can even create entries in an image index file or image index database table of every image and its relevant information, file name and location.

Eliminate rejected EDI transactions. Let only data into your system that has been checked for HIPAA compliance with our HIPAA EDI Exchange module. No more "garbage in, garbage out". Discover how you can manage EDI file Transport:

• Benefit from HIPAA compliance checks.
• Confidently manage your whole EDI protocol with acknowledgements and security. (many of your trading partners will require this)
• Log all your EDI exchanges and automate your process.

EDI File Transport - Sends and receives EDI files via the File Transport Protocol (FTP). The application supports all variations of this protocol: FTP, sFTP and FTPs (implicit and explicit). PGP encryption is supported.

HIPAA Compliance Check - It has a built-in EDI HIPAA compliance engine. All incoming and outgoing EDI files are checked for HIPAA compliance. A detailed report is created for every compliance issue. Transactions that are in violation will be held back based on HIPAA rules.

EDI Acknowledgements - It creates TA1 and 999 EDI Acknowledgement files when a trading partner wants to receive them.

Trading Partner Management - Keep track of multiple trading partners with their identifiers and configurations.

Automation - Integrates with any scheduler to allow automated processing. Gets files from trading partners, decrypts, checks for HIPAA compliance and calls the appropriate HIPAAsuite application for further processing.

Logs - Incoming and outgoing EDI files are logged with compliance check results stored in the database. Troubleshooting is easy with a daily log that list all activities and error messages.

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