From the Blog

An icon for a calendar


Adeptia’s HIPAA Integration Solution

Companies looking to automate HIPAA data processes often face multiple integration challenges such as managing inbound and outbound data feeds from external trading partners, connecting to backend EMR/EHR systems to perform patient updates, and providing a web-based reconciliation platform in the form of dashboards and web-forms to the healthcare service providers and carriers to resolve issues related to patient data or out-of-sequence policy changes.

Companies looking for an integration platform should also think about the long-term dependence on an integration platform that has the ability to scale as the number of trading partners, applications, users and the rules governing data change over time.

Adeptia offers a comprehensive HIPAA processing functionality as part of its B2B Integration Solution that makes it easier for companies to automate and process HIPAA messages. It helps you address some of the key questions such as how easy it is for a business user to set up a trading partner and onboard their HIPAA compliant healthcare data into the backend or cloud systems. It also addresses questions related to whether the solution architecture enables easy setup of trading partner data files (enrollments, claims, etc) and has an ability to map the data if custom fields are included in the client file. Does it allow for easy management of maps that are created for different trading partners over the long run and how are changes to those maps monitored and tracked.

Here is the video link on Adeptia’s HIPAA Integrations solution: 3-minute overview of the B2B Integration platform

Another important consideration is how easily you can track the messages and the transactions that are being exchanged by the provider and the payer. Visually rich dashboards reduce time to track and check on the status of the HIPAA transactions. Things like “did they receive what we sent” should take seconds to find out rather than going through tedious process of emails and phone calls.

Now let’s suppose your company has received HIPAA data from a trading partner, what if the provider didn’t include the correct information about a particular patient’s enrollment or claim. Maybe the data is incomplete and doesn’t include the necessary supplemental documents to process the healthcare provider’s request.

How does one do reconciliation on a message that is incomplete, incorrect or is out-of-sequence compared to the current policy information existing in the carrier’s system of records? If the HIPAA integration solution provides an automated workflow capability with tasks that can be tracked and monitored by the business users in order to fulfill healthcare needs of an individual then that is a huge improvement in addressing the manual processes that lot of companies have in place today. Automated workflows that are fully integrated with data repositories is an important part of a comprehensive integration solution offered by Adeptia.

Let’s look at some of the important advantages of using Adeptia’s B2B Integration Solution stack:


  • Entirely browser-based solution with visually rich graphical interface that is meant for business users and not Java or .Net developers
  • B2B Trading Partner portal for business users to setup new Providers, Payers easily through a web-based interface in minutes
  • Ability to configure routing rules to push or pull HIPAA data to and from your trading partners or any internal system by configuring real-time or batch triggers
  • Able to support all the different HIPAA versions such as 5010, 4010, etc.
  • A graphical mapper capability to allow business analysts to map HIPAA data such as 837 Claims or 834 Enrollments to backend systems
  • A flattened HIPAA, EDI X12 schemas minimizes the complexities of traversing through Loops and allows easier mapping of data to any target application
  • Pre-built mapping functions and templates that provide the ability to enrich the data through lookups, value-maps, conditions, filters, sorting, etc.
  • Achieve compliance by validating HIPAA inbound and outbound data against the specific versions and your business rules around data conversion, errors or partial data feeds
  • Able to automatically send and notify with 997 or 999 acknowledgments
  • Ability to track and monitor the status of data feeds through interchange, transactions, partners, and other business data fields
  • A meta driven SOA framework that allows for reusable maps, routing rules and trading partner configurations
  • Alerts and notifications in case of data or routing errors
  • Ability to resend a previously failed transmission to a trading partner
  • A workflow that enables business users to perform holds, reconciliations and resubmissions of HIPAA data back into the applications