HiPaaS EDIVal Prior Auth Workflow

For Providers

For Insurance Companies

• Prior Auth Workflow driven Web pages

• Real time 278 Prior Authorization Transaction for Payers Receive 278 Prior Authorization Transaction and security. Route the request to membership system or Pega system using intelligent router. Get the and manage 278 Prior Authorization Transaction responses, generate and send 278 X12 responses
  

• Batch 278 Prior Authorization Transaction Batch Receive 278 Prior Authorization Transaction request file from Trading Partners . Route the request to membership system using intelligent router. Get the 278 Prior Authorization Transaction response, generate and send 278 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
  

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

• View Prior Authorization Transaction Requests and Response time View incoming requests and outgoing responses, track response time , track AAA, Track compliance and response time
  

• Prior Authorization Transaction API Same Prior Auth data for other member touch points like web, provider portal, member portals, IVR and customer service port
  

• Prior Authorization on Kafka Stream Responses 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.