About the HIPAA Compliance Editor |
  
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About the HIPAA Compliance Editor |
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The HIPAA Compliance Editor application is an advanced tool for checking EDI files for compliance while displaying them in a readable format.
Checking EDI files is crucial to provide compliant EDI files in a consistent manner within HIPAA regulations, but this can be time consuming. With this tool, users will be able to identify errors within EDI files and fix them.
When processing directories, the HIPAA Compliance Editor sorts files into "Pass" and "Rejected" folders. For those files with error, the application will highlight it and provide a detailed description when the users clicks the highlighted area. After the EDI file is edited, the compliance check can be refreshed to ensure all errors have been fixed. A detailed error report is generated for every compliance issue on a file or multiple files. You can generate the report in Microsoft Word (.docx), Microsoft Excel (.xlsx), XML, and JSON formats.
In 1996, the Health Insurance Portability and Accountability Act (HIPAA), was the first attempt to create nationwide rules to enact administrative simplification and make the process of information exchange between healthcare payers and providers more efficient by employing EDI transactions. Compliance with HIPAA rules is essential in the exchange of EDI files, and adherence to these standards is important so that healthcare entities can work with them regardless of their back end system software.
By 2003, all healthcare entities were required by law to fully implement EDI on their transactions. The government, as the largest payer in the system through the programs of Medicaid and Medicare demanded that from there on, they would only accept standardized electronic transactions.
The HIPAA Act 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.
Maintaining ongoing compliance of these mandates, and eliminating Trading Partner complaints, can still be an operational challenge in the healthcare industry. Many Trading Partners reject EDI files with compliance errors, and this can result in their suspension. For this, all HIPAAsuite software include a built-in EDI HIPAA compliance engine within our EDI Exchange module that checks all incoming and outgoing files.
The built-in compliance engine uses Standard Exchange Format (SEF) files, which codify the transactions within each standard. EDI Exchange manages the full E-commerce communication protocol with Functional Acknowledgments (999), Transaction Acknowledgments (TA1), and automated flow.
However, there was a need for a stand-alone compliance with little set up time and easily accessible for users. To respond to this need, the HIPAAsuite compliance engine and Compliance Editor were combined to create the HIPAA Compliance Editor.
The HIPAA Compliance Editor comes with several features. The base application includes:
oDisplays raw EDI data in a readable format.
oChecks EDI files for HIPAA compliance.
oHighlights and offers a detailed description of errors.
oFix errors directly in the Editor and generate reports in multiple formats.
oAllows for manual and automated processing.
oSupports HIPAA SNIP validation level types 1 through 4.
oTree View allows easy navigation and displays envelop characters and errors.
oSorts EDI files into compliant and non-compliant.
You can also add modules to enable other features. See Enabling Application Components.