OVERVIEW
The HIPAAsuite RealTime Server is a self-hosted web service that enables the exchange of EDI transaction sets in real-time and batch mode. It full-fills all CORE requirements and is a certified software product by the CAQH. Find us in the certified vendor area.
Our CORE® certified HIPAA RealTime Server uses SOAP and MIME protocols to deliver electronic responses in less than 10 seconds.
The HIPAA RealTime Server integrates with the HIPAA Eligibility Responder, HIPAA Claim Status Responder and the EDI Exchange to implement real-time capabilities. Load your eligibility and claim status data into our tables, set up the program and become compliant with the CORE rules and the ACA in a short time.
The HIPAAsuite RealTime Server complies with the Phase I and II CORE rules which are mandated for Health Plans and State Medicaid for compliance with the Affordable Care Act (ACA).
PHASE I AND II CORE
The Coalition for Affordable Quality Healthcare (CAQH) is a group of stake holders in the healthcare industry who determined that real-time transactions will cut cost and increase the efficiency of the healthcare system.
CAQH established the Committee on Operating Rules for Information Exchange (CORE). CORE is dedicated to the development and adoption of national operating rules for healthcare administrative transactions.
The Affordable Care Act (ACA) requires insurance carriers to follow the CAQH® CORE® Operating Rules since 2013 and provide real-time eligibility and claims status information.
The providers in the healthcare industry are demanding from payers to have real-time capabilities because it saves them a lot of money. This technology shift will make the whole industry more efficient and save your organization a lot of money over time with an affordable investment. Providers need to know at the time of service whether a patient is covered by an insurance policy. Insurance payments are refused because the patient is not covered or a particular service isn’t covered. Obtaining a patient’s eligibility and benefits status in real-time is of great importance to eliminate later disappointments.
Secondly it is important for providers to find out the status of claims that were submitted to carriers.
Providers usually have a staff of people who spend their day hunting down missing payments for claims and waste hours on the phone to find out why a particular claim has not been paid and whether it should be resubmitted.
Getting eligibility and claim status information in real time, without human interaction will save countless hours.
Try our HIPAA RealTime Server and save money. Download the free trial today!
Design Principals
DESIGN PRINCIPALS
The CORE Connectivity Rules describe the complete data exchange between providers and carriers.
It offers two processing modes:
Real-time mode
Batch mode
It offers two transport protocols:
SOAP (XML based)
MIME (email related)
Requests have to be delivered within the 20 second to qualify for real-time.
Discover the easiest way to CORE compliance with our HIPAA RealTime Server.
Typical Flow for a Batch Transaction
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