HIPAA Eligibility Checker

Before starting a treatment, providers need to know the insurance coverage of a patient by a carrier. Many providers have staff to find out the benefits of a patient. The HIPAA act created the 270/271 EDI transactions to make this exchange of information electronically. Payers are required by law to respond to electronic Eligibility requests and the healthcare industry is pushing for the responses to be sent in real time.

Avoid annoying IVR systems and spending countless hours collecting information over the phone with our HIPAA Eligibility Checker. It has enabled providers to create electronic request in the 270 format and to receive and translate the 271 response.

See the features of the HIPAA Eligibility Checker:

• User friendly interface
• Manually create 270 electronic requests
• Creates 270 electronic request files from database
• Views 271 Eligibility response records
• Saves 271 responses into your database
• Combines requests and responses

A module that is optional and works with the HIPAA Eligibility Checker is our EDI Exchange. See here some of the following features:

• Manages all insurance carriers
• Handles encryption and transport
• Automates processes
• Includes CORE client for real time transmission
• Supports MIME and SOAP

Save money and time with our HIPAA Eligibility Checker. Download the free trial today!

The HIPAA Eligibility Checker will help hospitals handle larger volumes of eligibility requests by connecting to your database. After a one time setup process of importing some basic information on the patient, the HIPAA Eligibility Checker will convert this data into 270 Eligibility request files and send them out to carrier. The responses will be received and exported into different data tables for access by your system and processes.

Add EDI eligibility with our HIPAA Eligibility Checker. Download the free trial today!

The real-time client enables communications with CORE compliant SOAP or MIME servers.

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 Eligibility Checker’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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