healthcare edi software Caliber Health

Claim Balancing SNIP 3 for 837s and Post-Adjudicated Encounters

Ensuring that 837 EDI transactions meet validity checks is critical to improving auto-adjudication and encounter submission acceptance rates. SNIP Type 3 describes the rules for balancing header and detail levels of the Claim, Premium Payment and Remittance Advice transaction sets. Previously, our blog covered the logic required to balance 835 transactions. Now we’ll look at the steps necessary to balance claims with service lines, including Coordination of …

Tips for Processing Large EDI Files in QNXT

The Challenge   TriZetto QNXT is an end-to-end solution for health plan administration across multiple lines of business. QNXT uses a Microsoft BizTalk Server application called QNXT Connect to intake EDI and translate it into XML for processing; however, transforming an EDI file expands the size significantly. Large files can create a bottleneck causing BizTalk to slow or halt processing.  …

EDI Validation Software – Free Download | HIPAA 5010 Sets

EDI Validation Software With this EDI Validation Tool healthcare organizations can validate 837 files, 834 files, and other HIPAA X12 EDI file types. The X12 tools are used to test those files by reading, validating, and producing an X12 999 Acknowledgement (ACK). The 999 ACK informs the submitter that the EDI file was valid according to the receiver’s implementation guide.  This x12 …

EDI Testing Files for HIPAA Compliance – Free Download

The best option when EDI testing is to utilize a tool to generate files that meet compliance with HIPAA security regulations. Using sample X12 EDI files for system testing is standard practice for developers and avoids the risk and liability of compromising patient data.  The testing process ensure the ability to transmit files, accept and process response files, and correctly …

Submitting Workers Compensation Claims as 837s

Workers compensation claims can be submitted in EDI 837 format using a Healthcare EDI Software such as T-Connect. In this article we go over the special set of requirements for these transactions. In a standard 837, the 2000B loop always contains subscriber information (the primary insured individual). Claim level information (2300 loop) is nested beneath the 2000B loop in this …

healthcare edi software Caliber Health

SNIP 6 Line of Service or Product

What are the HIPAA SNIP types available in T-Connect EDI Software products? We get this question a lot, so we’ve been blogging about the different categories WEDI has defined to validate healthcare EDI transactions. Thus far, we’ve covered: WEDI SNIP Levels: SNIP 1 & 2 Integrity and Requirement Testing SNIP 3 Claim Balancing SNIP 3 Remittance Advice Balancing SNIP 4 Intersegment …

SNIP 4 EDI Intersegment Situational Rules

SNIP 4 EDI WEDI SNIP Types define sets of rules for validating EDI transactions such as 837 claims, 834 enrollments or 835 Remittance Advice. Previously, we’ve blogged about: SNIP 1 & 2 Integrity and Requirement Testing SNIP 3 Claim Balancing SNIP 3 Remittance Advice Balancing SNIP 5 External Code Set Testing This article focus on SNIP 4, which test situational rules spanning separate …

SNIP 3 835 Balancing

EDI 837 Claim and 835 Payment transactions have transformed the adjudication cycle for providers and health plans over the last two decades, but challenges remain in reconciling payments with claims. Recently, we’ve broken down the requirements for SNIP 3 claim balancing. Today we’ll focus on the 835 Claim Payment/Remittance Advice. Health plans submit 835s to providers (or their intermediaries) to …

X12 EDI Databases for HIPAA Transactions

Easily parse EDI files into database X12 HIPAA transaction set is used across the healthcare industry to transmit claim, enrollment and payment information. Given the importance and ubiquity of these EDI files, you might assume that translating them from ANSI to a relational database format would be well-supported with a range of options. In practice, a task as common as parsing a claim …

healthcare edi software Caliber Health

Notes from the 2018 WEDI Spring Conference

The 2018 WEDI Spring Conference mixed deep dives into emerging X12 standards with sessions centered on Open APIs and a greater unification of clinical and administrative data. Here are a few of the topics that jumped out at me, with some thoughts on what these healthcare data trends might mean for our T-Connect EDI Software customers. FHIR – The maturing FHIR standards arguably represent the most dynamic developments in HIT …