HIPAA Enrollment MASTER

The EDI 834 transaction set embodies a Benefit Enrollment and Maintenance record and follows HIPAA 5010 standards. The exchange is between the insurance carrier and a plan sponsor. The sponsor is an entity that pays and organizes benefits to its members. Enrollment records contain demographic information on the insured and the details of their coverage.

The most common features are:

• Browse 834 EDI files
• View enrollment record as a form
• All cryptic codes are translated into their descriptions
• Print and save enrollment records in PDF or TIFF format
• Export enrollments as tab-delimited or Microsoft Excel files
• Export enrollment and benefit data to any database
• Create 834 EDI files from your database
• Built-in HIPAA compliance check
• Automate processing, manage 999’s, TA1’s and more

HIPAA Enrollment Master is the best EDI software tool for the 834 file format.

View enrollments - Our forms are developed to explain in-depth the content of an electronic enrollment record. EDI files are notoriously difficult to understand. They were designed to enable data exchange between computer systems, not humans. The same goes for the 834 enrollment transaction. We developed the HIPAA Enrollment Master as a tool to view each record in a simple and clear format.

No more cryptic codes, every value is translated into their proper description. The individual benefits are well formatted to data elements only used by Health Insurance Exchanges are clearly portrayed.

Discover why the HIPAA Enrollment Master is the best tool for viewing electronic enrollments. Download the free trial today! >

Getting EDI data integrated with your system is the biggest task when adopting electronic processes. Our HIPAA Enrollment Master will export that data in an 834 EDI file and save it into your database. After that you will be able to apply your own processes and business rules.

HIPAA Enrollment Master supports the following database’s:

• Microsoft SQL Server
• Oracle
• MySQL
• IBM DB2
• ODBC compliant database

The HIPAA Enrollment Master stages your data in 3 tables. Within the schema it contains the full complexity of the HIPAA 834 EDI format. Feel free to customize tables anyway you wish and update the data in order to recreate the 834.

Discover why the HIPAA Enrollment Master is the best tool for managing electronic enrollment records. Download the free trial today! >

In many cases where a payer receives enrollment records in 834 format, they are required to send those records updated with their membership information back to government agencies and sponsors in the same format. This is especially true if a payer wants to participate with the Affordable Care Act (ACA) and Health Insurance Exchanges (HIE’s).

The HIPAA Enrollment Master is designed with this process in mind and will create an 834 EDI file from enrollment records stored within the database, using the same tables that it writes to when exporting EDI enrollment data.

The optional EDI Exchange component with it compliance engine will then check each record and even withhold it from processing if HIPAA compliance errors have been found.

It does not matter whether the enrollment records came into the database from an EDI file or if the tables are populated by another process.

Discover why the HIPAA Enrollment Master is the best tool for managing electronic enrollment records. Download the free trial today! >

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 Enrollment Master'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.

Provides the ability to convert 834 files to Excel or ASCII text files

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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