With EDI/HQ™ Healthcare for handling specific HIPAA EDI standards, you get all of the robust functionality that comes standard with EDI/HQ™, plus additional support for healthcare-specific transactions. Effectively process, validate and map HIPAA documents like claims, insurance eligibility inquiries, premium payments and more, all in compliance of HIPAA requirements.
Get EDI for HIPAA 5010 and ICD-10 Ready
By January 2012, transmission of healthcare claims, remittances, eligibility and status requests and responses must follow the new HIPAA 5010 standard. Are you ready? Our EDI Healthcare edition of EDI/HQ™ can help, by supporting all 5010 transaction sets.
The 5010 standard is also designed to support ICD-10 codes, which take effect in October 2013. A new coding system for documenting diagnoses, ICD-10 will increase the number of codes (from 14,000 to more than 69,000), the number of characters per code, and the code specificity. Be prepared, with EDI/HQ™ Healthcare.
EDI/HQ™ Healthcare Features
EDI/HQ™ Healthcare supports a variety of transactions and requirements specific to healthcare EDI, in addition to the extensive functionality that comes standard with EDI/HQ™.
- Supports all X12 and 5010 X12 Type 3 Technical Reports (TR3) adopted under HIPAA
- Supports Detailed (AK2/AK5 segments) and Very Detailed Functional Acknowledgements (IK3/IK4 segments) in 997 Functional Acknowledgements
- Supports Detailed (AK2/AK5 segments) and Very Detailed Functional Acknowledgements (IK3/IK4 segments) in 999 Implementation Acknowledgements
- Supports ST03 Implementation Version Identifier required by HIPAA 5010
- Includes support for the TR3 Addendum published in October 2010
- Provides additional healthcare-specific validation to meet HIPAA standards
See the healthcare-specific X12 transactions supported by EDI/HQ™ Healthcare:
- 270-B1 Eligibility for a health plan, inquiry — dental, professional and institutional
- 271-B1 Eligibility for a health plan, response — dental, professional and institutional
- 276-A1 Health care claim status, request
- 277-B3 Health care claim acknowledgement
- 278-A1 Referral certification and authorization, request
- 278-A1 Referral certification and authorization, response
- 820-A1 Health plan premium payment
- 834-A1 Enrollment and disenrollment in a health plan
- 835-W1 Health care payment and remittance advice
- 837-Q1-3 Health care claims—Dental, professional and institutional
- 837-P Health care claims—Retail pharmacy supplies and professional services
- 837 Coordination of benefits—Dental, professional and institutional
- 999-A1 Implementation acknowledgement for healthcare
Of course, EDI/HQ™ supports all major ASC X12 transaction standards.
Need additional support for HIPAA? 1 EDI Source offers HIPAA EDI Compliance consultants who can work with you to ensure your organization is meeting every requirement for 5010 transactions and ICD-10 codes. Contact 1EDISource today for a free consultation.