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 HIPAA transaction sets are used across the healthcare industry to format 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 …

healthcare edi software Caliber Health

Enhanced QNXT Integration – EDI Transformation and Tracking

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 HIPAA transactions, but the complexity of implementing business rules and lifecycle reporting on Electronic Data Interchange (EDI) data is a constant …

X12 Studio – PDF Claim Form Generator Feature

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 for 837I (Institutional).  Both forms are provided by the Centers for Medicare & Medicaid Services (CMS). The PDF claim files …

EDI Solutions Comparison for Healthcare

EDI Solutions – T-Connect Product Comparison Below we compare T-Connect EDI Solutions for Healthcare.  We offer these electronic data interchange (EDI) solutions: T-Connect SDK T-Connect Database plus SDK T-Connect EDI Gateway All three T- Connect EDI solutions utilize our powerful processing engine that can scale to process millions of claims, enrollments, and other 5010 transaction set types. Below you’ll find …