HIPAA Eligibility Responder
Automatically respond to 270 eligibility requests.
Save countless hours of customer service representatives' time for payers and providers by switching to our HIPAA Eligibility Responder.
- Automate 271 eligibility responses, even in real-time, to stay in compliance with HIPAA and the ACA.
- Solve complex tasks and learn how straightforward our solution is to implement.
- Enable a limitless number of providers to connect electronically while cutting costs and increasing efficiency.
Before a provider treats a patient in his/her office or in a hospital the eligibility for health care insurance will be established. A lot of time is waisted on hold or with complicated fax response systems. HIPAA introduced the X12 270/271 pair of EDI transaction sets to automate this important exchange of information, so now more and more providers and payers are starting to use it especially since the Affordable Care Act (ACA). To add more complexity, this law mandates payers to implement a real-time response solution for common provider request.
Our HIPAA Eligibility Responder manages these complex tasks of answering 270 electronic eligibility requests by automatically sending a 271 EDI file in real-time. Connect your membership and benefit data to our software and it will handle the rest:
- It receives 270 EDI request files
- It identifies the member
- It locates member benefit information
- It writes 271 EDI response file
- It sends 271 EDI files
- It does it real time (CORE certified)
HIPAA Eligibility Responder will make your organization more efficient. Download the free trial today! >
Features included with basic module:
- Read and parse 270 EDI files
- Create a response manually
- Create 271 response EDI files
For a payer to truly benefit from the EDI 270/271 eligibility transactions is by automating the whole process of receiving and responding to these electronic requests.
How does this get solved? The HIPAA Eligibility Responder knows how to turn a request into a response using your membership data. This is done after the initial setup process where you’ll connect your data with our software. Our EDI exchange module handles all the protocols, encryption and transport making this a complete HIPAA compliance solution.
Save money and time by automating your providers eligibility requests with our HIPAA Eligibility Responder. 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 Eligibility Responder'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.
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.