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.
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.
EEA 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.
Standards Support
The EXTOL Enterprise Adapter for HIPAA includes support for the following 5010 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)
Built-In Translation Support
Inbound & Outbound Standard Side Maps
EEA for HIPAA contains “base” EDI standards-side maps for each of the supported HIPAA transactions. 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.
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) based on the 4010 requirements.
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 (outbound). 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
EEA 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 Exchange product, the EEA 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.
Request Info
