HiPaaS EDIVal Eligibility

For Providers

Inbound 270 Request and 271 response - For Insurance Companies

• CORE Compliant 270/271 Real time Eligibility Check for Payers Receive CORE compliance Eligibility Check using SOAP XML and security. Route the request to membership system using intelligent router. Get the claims status response, generate and send 271 X12 response
  

• Eligibility Check 270/271 Batch Receive Eligibility Check request file from Trading Partners . Route the request to membership system using intelligent router. Get the Eligibility Check response, generate and send 271 X12 response
  

• 999, TA1 Response Create and send 999, TA1 based on SNIP L1 / L2 Validation results based on the Companion guide configuration. Outgoing 999 is attached to Graph Node and available to audit
  

• HETS Integration Integrate with HETS Medicare and validate and send Eligibility Check files. Integrate to other large trading partners
  

• Prebuilt mappings - QNXT, Facets and Healthedige Prebuilt mappings, connectors and integration to QNXT, Facets and healthedge systems
  

• View Eligibility Check Requests and Response time View incoming requests and outgoing responses, track response time , track AAA, Track compliance to BX score
  

• Eligibility Check API Same Eligibility Check data for other member touch points like web, provider portal, member portals, IVR and customer service port
  

• Eligibility Check on Kafka Stream Eligibility Check on Kafka streams
  

• Views and Alerts Setup different business threshold alerts and notify business. Define analysis views by Provider, by trading partner, Submitter and others.