Healthcare Data Integration Wellness

With Adeptia, companies can increase their clear rate by identifying and correcting claims errors before they are processed. And, because the data integration process remains in the hands of business users, they’re able to quickly spot, correct, and resubmit claims in just minutes. That allows them to unlock millions of dollars in claims that traditional integration solutions miss, dramatically increasing your productivity and maximizing profit margins.

Adeptia software enables healthcare data interoperability that providers need to reduce errors, duplicative testing, and delays in providing care.  Adeptia enables you to quickly and easily share data in a HIPAA (Health Insurance Portability and Accountability Act) compliant manner including electronic healthcare transactions and national identifiers for providers, health insurance plans, and employers. Coverage for all EDI transaction sets are available including:

• • Healthcare Eligibility/Benefit Inquiry-EDI 270: For inquiring about healthcare benefits and eligibility associated with a subscriber or dependent.
  • Healthcare Eligibility/ Benefit Response-EDI 271: For responding to a request inquiry about the healthcare benefits and eligibility associated with a subscriber or dependent.
  • Patient Information Transaction Set-EDI 275: This document is used for healthcare patient information requests and responses. It allows healthcare providers to request patient information from other healthcare providers or organizations.
  • Healthcare Claim Status Request-EDI 276: Can be used by a provider, recipient of healthcare products or services, or their authorized representative to request status of a claim.
  • Healthcare Claim Status Notification-EDI 277: Can be used by a healthcare payer or authorized agent to notify a provider, recipient or authorized agent the status of a claim or encounter, or to request additional information.
  • Healthcare Service Review Information-EDI 278: Used to transmit healthcare service information, such as subscriber, patient, demographic, diagnosis, or treatment data for review, certification, notification, or reporting review outcomes.
  • Payroll Deducted and Other Group Premium Payment for Insurance Products-EDI 820: A transaction set that can be used for making premium payments for insurance products. 
  • Benefit Enrollment and Maintenance Set-EDI 834: Used by employers, unions, government agencies, and insurance agencies to enroll members to payer, which is a healthcare organization that pays claims or administers insurance, benefits, or products. 
  • Health Care Claim Payment/Advice Transaction Set-EDI 835: For making payments, sending EOB (Explanation of Benefits) remittance advice, or making payments and sending EOB remittance advice only from a health insurer to a healthcare provider either directly or through a financial institution.
  • Health Care Claim Transaction Set-EDI 837: Used to submit healthcare billing information or encounter information (except for retail pharmacy claims). Can be sent from healthcare service providers to payers, either directly or through intermediary billers and claims clearinghouses. 
  • Functional Acknowledgment EDI 997: Most healthcare industry EDI document acknowledgement is now done using the EDI 999 document—see below. We’re including mention of it here as the 997 may still be in use by some older integration implementations (prior to adoption of the ANSI 5010 standards). Whereas the EDI 997 simply provided indication that an EDI document was securely received, the newer EDI 999 transaction set provides additional response detail as described below.
  • Implementation Acknowledgment EDI 999: The 999 Implementation Acknowledgment, is used for the acknowledgment of received EDI transactions as a response to the sender. It serves as an indication that the received transaction(s) were accepted or rejected based on syntactical data, conformance of data formatting, and data structure validations. An affirmative EDI 999 indicates that the referenced transaction(s) will be processed by the receiver’s system, and the structure and syntax of the data meet data compliance standards. Response codes in the EDI 999 document provide additional details about the acceptance or rejection of specific transactions. For rejected transactions, error codes and descriptions identify the specific issues that caused the rejection. The sender can use the EDI 999 to verify the status of their transmitted data and take appropriate actions, such as correcting rejected transactions and re-sending them.
  • Retail Pharmacy Claim Transaction- EDI NCPDP Telecommunications Standard Version 5.1:  For submitting retail pharmacy claims to payers by healthcare professionals who dispense medications, either directly or through intermediary billers and claims clearinghouses.

• Integrate and centralize core applications such as clinicals and patient accounting, along with healthcare ancillaries such as lab, pharmacy, and materials management.
• Empower healthcare stakeholders with management insight for critical decision-making by creating new views of the data.
• Free up IT and administrative staff to spend time on core concerns such as ensuring swift receipt of revenues instead of spending time and effort on hold with payers and repeatedly keying in data on a payer’s website to check current claims status in the adjudication process.
• Leverage your existing technology investments by pulling critical data and processes across the entire revenue cycle (e.g. scheduling, pre-registration, registration, care management, post-visit, patient management, and collection management).
• Fully support healthcare data standards, including HIPAA, NCPDP and HL7.
• Learn more about how Adeptia supports HIPAA Integration.
• Learn more about HL7 Integration in Adeptia.