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Edit and Resubmit X12 HIPAA EDI with the T-Connect Management Suite

Kyle Keel

An EDI software’s ability to identify and respond to invalid X12 HIPAA EDI transactions is a major contributor to the effectiveness of EDI dependent organizations. Many healthcare companies appoint a business unit as stewards of the tens of thousands of…

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X12 Studio – PDF Claim Form Generator Feature

Kyle Keel

Exporting X12 837 claim files into standardized CMS1500 or UB-04 forms is simple with T-Connect X12 Studio Toolbox’s PDF Claim Form Generator. CMS1500 is the standardized form for X12 837P (Professional) EDI files.  The CMS1450, aka UB-04, provides the form…

EDI_Analytics

Enhanced QNXT Integration – EDI Transformation and Tracking

Kyle Keel

TriZetto’s QNXT is a widely adopted platform for claim processing and membership administration. QNXT relies on the Microsoft stack, particularly BizTalk, .Net and SQL Server, to process and store EDI messages. These technologies give developers many tools for customizing and tracking…

Notes from the 2018 WEDI Spring Conference

Kyle Keel

This year’s 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 trends…

X12 EDI Databases for HIPAA Transactions

Kyle Keel

The 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…

SNIP 3 835 Balancing

Kyle Keel

835 and 837 EDI 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…

SNIP 4 – EDI Intersegment Situational Rules

Kyle Keel

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…

SNIP 6 – Line of Service or Product

Kyle Keel

What are the HIPAA SNIP types available in T-Connect EDI Management Suite? 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: SNIP 1…

Submitting Workers Compensation Claims as 837s

Kyle Keel

Workers compensation claims contain a special set of requirements when submitted in the EDI 837 format. This article describes these specific characteristics. In a standard 837, the 2000B loop always contains subscriber information (the primary insured individual). Claim level information…

EDI File Generator, HIPAA Compliant Testing – 4 Easy Steps!

Kyle Keel

Need a way to test your systems without compromising patient data? Creating Electronic Data Interchange (EDI) test files from scratch can be an extremely time-consuming option. This leaves many searching for downloadable sample files that often contain only the mandatory loops and…