About HIPAA Eligibility Checker |
  
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About HIPAA Eligibility Checker |
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The HIPAA Eligibility Checker application is a tool for providers of healthcare services to verify if a patient is covered by a health insurance policy electronically. It allows users to create electronic eligibility requests, send them to the payer, and receive and interpret the response. This reduces or eliminates the time consuming process of having staff calling to inquire about patient eligibility and other related matters.
The application creates EDI 270 files and receives 271 Eligibility Response transaction files, converting EDI information into readable and printable forms.
The HIPAA Act of 1996 was the first attempt to create nationwide rules to enact administrative simplification and make the information exchange process between providers and payers more efficient. For this, Electronic Data Interchange (EDI) was employed. The government, through its National Bureau of Standards, is the guardian of the rules and details of the different EDI transactions for each involved industry. See more on EDI in EDI Files.
The original HIPAA Act described EDI 270 as the transaction set for the eligibility request and EDI 271 for the eligibility response. However, it did not specify the necessary infrastructure, such as transport protocol. This changed with the Affordable Care Act (ACA or Obamacare), which adopted the rules developed by the Coalition for Affordable Quality Healthcare (CAQH), a consortium of healthcare industry providers and insurers. They devised and prescribed mechanisms to transfer eligibility information in real-time between two computers, which greatly enhanced the efficiency of establishing insurance coverage for a patient.
HIPAA Eligibility Checker comes with several features. While the basic version has no database attached, it does allow for:
oManual entry of eligibility requests,
oImport of 270 Eligibility Request files that were created somewhere else and editing of the information,
oDisplay and printing of eligibility requests in a readable format, with all the cryptic codes translated,
oCreation of 270 EDI files, and
oReading, displaying, and printing the information of 271 Eligibility Responses in a readable format with all the cryptic codes translated.
Transporting EDI files to the payer and receiving the responses is left to other devices in the basic version.
HIPAA Eligibility Checker comes in a basic-function version. However, you may add modules to enhance the features of the application. You may do this via licenses; please visit our website or contact us for more information. The following are some of these additional modules:
This module allows for the saving in TIFF or PDF format of the display images from 270 and 271 files.
By tying the HIPAA Eligibility Checker to a database, you can save eligibility request and response records and link the request with the response. In addition, there are tables available for the company setup. Also, requesters, subscribers, and providers used in the manual entry forms are remembered, making data entry faster.
This module expands the functionality of the software by adding all that is necessary to transport the 270 request files to the payers and receive the responses. EDI Exchange handles the Trading Partners and their specific configurations, encryption, FTP, SFTP, logs incoming and outgoing files, checks incoming and outgoing EDI files for HIPAA compliance, and more.
The HIPAAsuite RealTime Server is an add-on to exchange requests with payers and receive responses in real-time or batch mode according to the CORE protocols MIME and SOAP.