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Tallan’s Experts Share Their Knowledge on Technology, Trends and Solutions to Business Challenges

X12 Studio – Validate and Retrieve 999 Acknowledgements

Stan Kennedy

Overview
X12 Studio provides validation capabilities that can be used to validate claims, enrollments, and other HIPAA X12 EDI file types.  X12 Studio can be used to test those files by reading, validating, and producing an X12 999 Acknowledgement (ACK).  The 5010 999 ACK replaced the previous version – 4010 997 ACK.  The 999 ACK informs the submitter that the EDI submitted is validated according to the receiver’s implementation guide.  This validation includes the results describing the quality of the functional group’s syntax.  Sometimes this validation is referred to as WEDI SNIP level edits 1 and 2.
Steps to Generate the 999 ACK

To start, download X12 Studio and install the application:

Launch the application and open an existing 837I, 837P, 834, or any of the HIPAA X12 EDI files:

Click on the Generate ACK 999 icon in the top menu:

View the Output tab at…

Optimizing Your Business for Voice Search

Anthony Divanna

“Hey Google, how can my business be at the top of all of my clients’ search results?” Between Siri, Google, Alexa, and Cortana, searching for anything and everything has never been easier. As technology becomes more and more hands-off, businesses need to be more hands-on in ensuring they can keep up with the times.
By the end of 2019, at least half of all searches will be voice searches – this includes not only personal queries such as “What’s the weather”, but more business-related questions like “Where is the closest place for me to replace my tire today”. According to market research, 76% of people who search for something nearby on their smartphones visit a related business that day, and 28% of those searches result in a purchase. Smart speakers also add to voice search analysis.  Nearly one in five U.S….

A HIX 820 Overview

When the Health Insurance Exchange (HIX) network went online in late 2013, the industry was challenged with reconciling new subscribers to their related premium payments and subsidies. Health plans painstakingly assembled Excel eligibility extracts to invoice their Federally Facilitated Marketplace (FFM) or State-based Exchange (SBE) for tax credit reimbursement. However, by the start of 2016, the FFM became the system of record for eligibility, and issuers were required to accept a new variant of EDI representing premium payments.
Traditionally, the 820-Payment Order / Remittance Advice transaction (005010X218) has been transmitted from payroll agencies and government healthcare organizations to insurers in order to provide summary or subscriber-level information regarding premium payments. With the advent of ACA exchanges, enough variations surfaced in this traditional handshake that a new version of the 820 was required. The HIX 820 (005010X306) removes structures unnecessary for exchange reporting, and adds tracking segments for the unique aspects of these plans, such as…

X12 Studio – PDF Claim Form Generator Feature

Stan Kennedy

Exporting X12 837 claim files into standardized CMS1500 or UB-04 forms is simple with T-Connect X12 Studio Toolbox’s PDF Claim Form Generator. CMS1500 is the standardized form for X12 837P (Professional) EDI files.  The CMS1450, aka UB-04, provides the form for 837I (Institutional).  Both forms are provided by the Centers for Medicare & Medicaid Services (CMS). The PDF claim files can be used to view, archive, or manage EDI claims into a human-readable form.  Our Claim Form Generator feature is a very useful tool for EDI Analysts, overlaying 837 EDI data onto industry-standardized forms.
Steps to Generate the PDF 1500CMS or UB04 Forms

To start, download X12 Studio and install the application:

Launch the application and open an existing 837I or 837P X12 EDI format:

Click on the Generate PDF icon in the top menu:

View the Output tab at the bottom of the application. This…

Row-Level Security in Power BI: Part 1 – Roles and Users

James Arey

Securing Reports
Let’s say the Finance Department of a clothing retailer has some great reports that let them see all the sales across the United States; so great, in fact, that they want to share them with all Regional Managers so they can communicate about the hot spots in their region. The problem is the Regional Managers aren’t permitted to see data outside their region, and giving them access to these reports would allow them to filter to any region they wanted. We could create separate Datasets and reports filtered to the region for the manager that is given access to them, but that would be time-consuming, and a nightmare to maintain. Luckily, Power BI provides the ability to implement Row-Level Security (RLS).
So, what is RLS? Simply put, it controls a user’s access to each individual row of the Dataset. In…

Simplify Your Mobile Presence With Progressive Web Apps

Matthew Gajdosik

The biggest thing we take for granted in the current mobile-dominated web is that everything “just works”, no matter what size or type of device you’re on. But what’s the real impact of that expectation?
For customers, the frustration of needing to switch devices can be more than enough to turn them away from a certain product. For product owners, there’s an expectation that everything needs to be created in parallel to be desktop-friendly, tablet-friendly, mobile-friendly, and to have an equal native mobile app for every platform, which can quickly add up in cost. And for developers, there’s the fact that now you have to actually make all those versions of the same app, across completely different technologies for web and native, and have them work similarly enough to not raise any eyebrows.
But luckily, there’s a new way of doing things,…

Introducing the ‘Calendar by Tallan’ Power BI Custom Visualization

Kenneth Philcox

The Microsoft Office Store contains a growing library of custom Power BI visualizations developed by Microsoft and the community. While Power BI offers built-in visualizations, custom visuals can be downloaded for free and are used to enhance the way you display your data within reports and dashboards. Tallan has now taken its Power BI expertise to the next level by contributing our very own custom visual. Introducing the ‘Calendar by Tallan’ Power BI Custom Visual!

When associating dates with data, the first real-world visual that comes to mind is a standard 12-month calendar. While other custom calendar visuals exist in the Office store, the offerings did not portray the dates in this familiar manner or display the range of data desired. Tallan’s Calendar visual enables you to view the aggregation of data across a range of dates in a standard calendar…

Claim Balancing – SNIP 3 for 837s and Post-Adjudicated Encounters

Ensuring that 837 EDI transactions meet validity checks is critical to improving auto-adjudication and encounter submission acceptance rates. SNIP Type 3 describes the rules for balancing header and detail levels of the Claim, Premium Payment and Remittance Advice transaction sets. Previously, our blog covered the logic required to balance 835 transactions. Now we’ll look at the steps necessary to balance claims with service lines, including Coordination of Benefits loops in multiple payer scenarios.
Claims and encounters may be represented by a variety of X12 transaction types: 837 Professional, Institutional and Dental, as well as their corresponding post-adjudicated variants (298, 299, 300), intended for submission to All-Payer Claims Databases. The following logic applies to all versions of the 837 equally, with a few caveats noted below.
Rule 1 – Balancing Claim Charge Amounts
The first claim balancing rule is straightforward: given the parent-child relationship of 2300 claim loops to their 2400 service…

Edit and Resubmit X12 HIPAA EDI with the T-Connect Management Suite

Kevin Morillo

An EDI software’s ability to identify and respond to invalid X12 HIPAA EDI transactions is a major contributor to the effectiveness of EDI dependent organizations. Many healthcare companies appoint a business unit as stewards of the tens of thousands of transactions that are transmitted between payers, providers, and trading partners providing auxiliary services. These business units are often hard-pressed to respond to the quantity of incorrect claims, enrollments and payments received within their current EDI solutions or products.
The T-Connect EDI Management Suite is Tallan’s healthcare EDI product, providing actionable insight, alerting, and painless mechanisms to respond to invalid X12 EDI transactions flowing in and out of the organization. The following is a brief introduction into some of these capabilities.
The EDI solution consists of several components working in unison to introduce, augment or replace an EDI processing system.
· The T-Connect Management Portal,…

Generate HIPAA EDI Testing Files – 4 Easy Steps!

Paul Gutierrez

Need a way to test your systems without compromising patient data? Creating Electronic Data Interchange (EDI) test files from scratch can be an extremely time-consuming option. This leaves many searching for downloadable sample files that often contain only the mandatory loops and hinder the scope of your HIPAA EDI testing.
Fortunately, today’s Healthcare EDI professionals can find an EDI Management Platform to help alleviate their HIPAA compliance headaches.
The T-Connect EDI management suite features the X12 Studio EDI Toolbox, an EDI development toolkit with a wide range of features that are essential to simplifying the EDI development process. There you’ll find the HIPAA Test File Generator which can generate various sample EDI files, for any healthcare EDI transaction type, in the blink of an eye.
This post will demonstrate how to generate EDI test files in X12 Studio EDI Toolbox

1. The process for utilizing the HIPAA Test File Generator is straightforward. To start, click on the “HIPAA Test File…

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