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What is the HIPAA Claim Master application?

The HIPAA Claim Master application is an advanced tool for processing healthcare Electronic Claims.

 

HIPAA Claim Master reads X12 837 EDI claim files, parsing the claim information with its built-in EDI translator into distinct claims. These can then be rendered as an image of a UB-04, CMS-1500, and ADA 2024 form or the older formats. These images can then be viewed on screen, printed, or turned into image files, PDF, and TIFF formats. They can also be added to an image management system.

 

In addition, HIPAA Claim Master can import claim data to any database. Claim tables can be created within any ODBC/OleDB-compliant database such as a Microsoft SQL Server, Oracle, or MySQL. The claim data is then accessible to the user's applications. Also, users can search this data warehouse and even recreate the image.

 

Background

Electronic claims were introduced in the 1990s and made mandatory by January 1, 2003. Now, more than 90% of claims are transmitted electronically. HIPAA Claim Master was first launched in 2001 as a solution for easier claim processing while complying with all safety standards. Newer versions are released periodically based on Microsoft's .Net infrastructure.

 

The HIPAA Act of 1996 mandates that every medical claim transmitted electronically must conform to strict standards. These standards are developed by the American National Standards Institute (ANSI), under the umbrella of the X12 Committee for Electronic Data Interchange (EDI). X12 contains standards for hundreds of electronic data interchanges that are constantly under development. Medical claims are contained in the 837 Transaction Set. The HIPAA Claim Master application supports both HIPAA-compliant versions 4010A1 and 5010.

 

There are four categories under the 837 Transaction Set, all supported by the HIPAA Claim Master application: