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August 6, 2015

Avoiding the headaches and high costs of consolidating healthcare data.

Many entities operate in the space serviced by the ANSI X12 HIPAA EDI transaction set.

Common documents are:

  • Benefit Enrollment and Maintenance (834)
  • Claim Payment Advice (835)
  • Professional and Institutional Claims (837 P, 837 I)
  • Various status inquiry documents (270, 271, 276, 277)

 The originators of these documents are the employers, providers and payers that book-end the process of working these documents, but in between we find a wide variety of data service providers in need of loading HIPPA transactions in bulk for analysis or in concert with real-time business processes.

Some examples include:

  • Third-Party Administrators
  • Brokers and Exchanges
  • Claim Repricers
  • Clearinghouses
  • Consultants

These companies are faced with loading massive data sets, periodic data streams, returning real-time status—or a combination of all of these challenges.

And so often it’s complicated by the healthcare space having multiple encodings available outside of the X12 EDI and the same document types are sometimes traded as XML, CSV or flat file formats by groups without EDI capabilities.

This challenges the small- to medium-sized healthcare intermediary because of the need for a sophisticated ETL tool to populate their data management system.

Often, these are custom SQL databases with data models reacting to the needs of the first customer request and then presenting challenges for dealing with future customers with different expectations.

Programming and reprogramming your data model or data processing software is expensive, the talent is hard to source, and then once the system is in place, most of the documentation of it lives only with the original developer. HIPAA regulations require data in motion to be handled carefully, so in some cases this exposes the company to regulatory risk and the burden of certification.

Traditional ETL Process

The solution is a platform that can normalize the data in a way that does not require expensive programming.

EDI/HQ from 1 EDI Source has been designed with this HIPAA workflow in mind. It takes disparate file formats, various versions of the EDI standards, and numerous implementations within the same version across multiple partners and converts it to a single unified data model. This model conforms to your existing systems so the current data warehouse can be retained and not have to be retooled.

Since EDI/HQ is an off the shelf (OTS) toolset, it can be deployed in minimum time and with minimum risk. Replace your expensive codebase with a much smaller predictable annual fee and use the talents of your business analysts to map data to your warehouse instead of hiring and training a programmer to learn your value to the healthcare data network.

1 EDI Source ETL

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To talk to one of our EDI experts, call 877-334-9650 or email us at sales@1edisource.com