HiPaaS EDIVal Premium Dashboard

CFO Dashboard - Reconcile Premiums with Eligibility Data

• CFO Dashboard - Reconcile Premiums with Eligibility data
  

• 820 Payment Loader Load 820 files with our scalable Loader optimized to handle large load. Premium Payments are loaded in Graph Database and available to process in seconds.
  

• 820 Premium SNIP L1/L2 Validator SNIP L1 / L2 Validation of Premium files before loading. Generate error file. The companion guide can be configured by Trading Partner, payer or provider. Companion guides can be changed on fly and tested with incoming files.
  

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

• View Premium Payment 820 data View Premium Payment 820 data on HiPaaS UI. Check the file load status, Check the validation status. Volume analysis. Find any Premium items. Drill down on validation error
  

• Create Premium Payment entry Create Premium Payment manually via our data entry screen
  

• Auto Correction and Auto Learning Configure and setup auto corrections of repeating data mistakes by trading partners and providers so that the Premium payments can be reconciled. Define workflow to hold the Premium for specific conditions.
  

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

• Compare Premium to Enrollments and Coverage - Auto compare Compare the incoming premium data to membership coverage data at the time of premium payment and identify differences and missed payments by state or CMS
  

• Compare Premium Payments to Outbound vendor payments Compare inbound Premium payments to outbound vendor and provider membership payments and coverage sent to provides. Validate PCP assignments and changes