EXTOL Enterprise Adapter for HIPAA Print E-mail

Introduction

By now, most organizations affected by the U.S. Federal Government HIPAA mandate have come to grips with the magnitude of its impact on their IT systems. The truth is that HIPAA compliance involves far more than a new set of electronic transactions; it requires a fundamental change in the way most systems accept, manage, and create business transaction data.

MEETING THE HIPAA CHALLENGE

The challenge for Healthcare providers, payors, and processors is to accept, store, manage and integrate HIPAA electronic transactions with existing application systems, and do so in a way that minimizes changes to existing applications, and accommodates future changes to both applications and the HIPAA standard.

EXTOL’S UNIQUE ANSWER TO HIPAA

Based on its EXTOL EDI Integrator for i offering, EXTOL has delivered a unique and affordable solution for HIPAA integration that enables you to comply with the mandate for electronic transactions faster, and with less disruption to your application systems. The EXTOL Enterprise Adapter for HIPAA was designed to work with EXTOL EDI Integrator for i to solve the fundamental implementation challenges of HIPAA, namely, the communication, management, integration, and auditing of both HIPAA and related application data.

Functional Overview

The heart of the EXTOL Enterprise Adapter for HIPAA solution is a relational data store that captures, manages, and continually maintains information on the status of your HIPAA interactions with partners. Among other advantages, this makes inbound data available for turnaround processing. The EXTOL HIPAA Enterprise Adapter uses different sections of the data store to stage inbound and outbound HIPAA transactions.

The EXTOL Enterprise Adapter for HIPAA includes a comprehensive set of translation maps that import inbound HIPAA transactions and generate HIPAA standard outbound transactions. Applications can combine relational datastore content with inbound transaction data staged previously, to support turnaround processing. Over 1750 code tables, which are used in map processing to translate between application data element formats and HIPAA-compliant formats, are also included in the product.

Functions and Features

Standards Support

The EXTOL Enterprise Adapter for HIPAA includes support for the following 4010* HIPAA-mandated transactions:
  • 270 – Eligibility/Benefit Inquiries
  • 271 – Eligibility/Benefit Information
  • 276 – Claim Status Request
  • 277 – Claim Status Notification
  • 278 – Service Review Information
  • 820 – Payment Order Remittance
  • 834 – Benefit Enrollment
  • 835 – Claim Payment/Advice
  • 837 – Claim (Institutional, Professional, Dental)

*Note: Support for the 5010 Standards will be included in the next release of the EXTOL Enterprise Adapter for HIPAA.

Built-In Translation Support

Inbound & Outbound Standard Side Maps

EXTOL Enterprise Adapter for HIPAA contains “base” EDI standard side maps for each of the supported HIPAA transaction. These maps were built to follow the appropriate Implementation Guide, and are customizable in order to access application files and partner specifications.

Pre-Loaded Code Tables for Data Conversion/Validation To establish cross-referencing between application-specific data elements and corresponding HIPAA data elements, EXTOL Enterprise Adapter for HIPAA includes customizable, pre-loaded code tables. EXTOL Enterprise Adapter for HIPAA uses these tables for translation between customer-defined formats and HIPAA transaction formats.

EXTOL EDI Integrator for i features The EXTOL Enterprise Adapter for HIPAA utilizes the translation and audit features of the EXTOL EDI Integrator for i, such as Formula Processing, External File Lookup, Audit and Logging, User View and Advanced Auto Mapper.

Turn-Around Transaction Support

Turn-around Datastore
For the processing of turn-around HIPAA transactions (270/271, 276/277, 278), the EXTOL Enterprise Adapter for HIPAA includes turn-around database files. This enables data from the inbound request transaction (271, 276, 278) to be used to generate the outbound response transaction (271, 277, 278). This is essential for turn-around processing.

Inbound & Outbound Translation Maps
EXTOL Enterprise Adapter for HIPAA contains translation maps used to populate the turn-around database (inbound) and create HIPAA-compliant transactions (out-bound). These maps are customizable in order to access application files instead of or in addition to the turn-around datastore.

Copy Data Utility
This function copies a translated inbound request transaction to the outbound response files in the turn-around database. These files then can be used in the creation of the outbound HIPAA transaction.

Database Maintenance
EXTOL Enterprise Adapter for HIPAA includes a complete set of interactive functions to display, modify, add, delete or purge the contents of the Turn-around datastore.

Secure Communications Options In conjunction with the EXTOL Secure product, the EXTOL Enterprise Adapter for HIPAA and EXTOL EDI Integrator for i can communicate with trading partners using a variety of secure Internet communication options including AS2, and secure FTP. In addition, the EXTOL Portal service enables communication with partners connected by VANs and private networks, as well as the Internet.

System Requirements
Same as EXTOL EDI Integrator for i (EEI)