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Tracking and Fixing Encounters, Enrollments and other EDI with T-Connect

There are several ways to intake, parse and route encounters, enrollments, payments and other HIPAA X12 EDI files. However, there are often deficiencies that become quickly apparent, as not many systems provide an adequate level of insight into the status of the in-flight files, nor do they have the tools needed to respond to issues once they arise.

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Common Pitfalls

Putting on the hat of an analyst or operator tasked with ensuring that claims are successfully processed from intake to delivery, I may have a few key concerns with any system in the overall processing workflow.

  • Tracking the life-cycle of claims is difficult or requires many steps
  • Troubleshooting failed messages and determining root causes is time-consuming and requires both business and technical expertise to dig through complex systems
  • Re-submission often requires reprocessing the entire file or manual edits to files in unfamiliar formats
  • Resolving these issues commonly results in hours or days of lost productivity.

Some of these concerns originate from the system chosen to handle the EDI. Tracking may be difficult if intake, validation, transformation and routing of EDI files is performed by custom in-house applications. As is often the case, custom systems that have evolved over many years of in-house development may not provide a clear understanding as to what files may have failed, or why.

If gateway operations are performed by an integration platform or other off-the-shelf solution, then specialized expertise may be needed to translate seemingly cryptic error messages and determine the root cause of an issue.  For example, as detailed in a recent blog on EDI Reporting and Tracking, an error may be presented as several related errors referencing different files in XML format. However, without experience and knowledge in how EDI is translated into XML, the task of determining the root cause and fixing it can be quite overwhelming.

A Simpler Approach Using T-Connect

With the T-Connect EDI Management Suite, viewing the status of your encounters, enrollments and other EDI files is simple and approachable. For example, below is a screenshot showing a sampling of encounters and their statuses.

2018-09-17 13_06_31-mRemoteNG - confCons.xml - tconnect-demo

 

Within the Messages page of the EDI Portal, there are several things that can be accomplished:

  • Drilling down to a narrower set of files by utilizing the date filters.
  • Including a filter on any element within the file, such as an ID, name, or control number. The list of element names is also configurable and can include any element contained within any EDI file.

2018-09-17 13_18_06-mRemoteNG - confCons.xml - tconnect-demo

Aside from the clarity in the files that have succeeded and those that have failed, it is also just as simple a task to identify the issues within the files. The screen capture below shows the ease in viewing status of every subprocess or step that the file went through from its initial intake to its ultimate completion. Some of these steps include:

  1. Intake of the file, a HIPAA 005010 837 Professional file with 10 encounters.
  2. Validation of the file using WEDI SNIP rules.
  3. Validation resulted in splitting of the file to extract and hold the 1 invalid encounter for later processing.
  4. The 9 valid encounters were retained in another file that ultimately continued on and was persisted into the T-Connect EDI Databases.

Messages

It is important to note that we can see the validation error encountered in the file by selecting the Validation step showing the 1 in the Error Count column. This clearly shows that there was a single validation failure (SNIP 2) encountered where the PER communication number segment contained an invalid PER03 element of ‘AAA’. This level of clarity is not often obtainable with other off the shelf EDI gateways, integration platforms, or EDI processing engines.

2018-09-17 14_09_04-mRemoteNG - confCons.xml - tconnect-demo

The natural next step after identifying that an error has occurred, is to determine what can be done to remedy it, and hopefully remedy the issue without jumping through many hurdles. Thankfully, resolving the validation error is just as easy as identifying the error.

As can be seen in the screen capture below, clicking on the ‘view message’ icon opens up the currently selected file in our free EDI editor. X12 Studio presents the EDI in it’s natural hierarchical structure, along with all validation errors, and lists values for fields that require certain values selected. Generating 999 Acknowledgements and CMS 1500 and UB04 claim forms are some of the other capabilities provided by X12 Studio.

Resubmission

The error message shown in X12 Studio matches the error message shown in the portal previously. Clicking on the error in the ‘Validation Results’ tab highlights the PER error in the file. Selecting the PER03 element shows the 3 possible values for PER03 [EM, TE, and FX]. Now we know that the PER segment is a communication number, and the PER03 element represents the qualifier associated with the PER04 value a phone number in this case. Thus, selecting ‘TE’ from the list immediately re-validates the file and clears the error displayed.

Next up is resubmitting the now fixed encounter into the system for re-processing, also shown in the screen capture above. Re-processing, after being queued up, can be done either immediately, or as a scheduled batch for all resubmitted files. Below, we can see that after resubmission, the now corrected encounter was re-validated successfully, persisted to the T-Connect EDI Database.

ResubmissionStatus

Conclusion

As shown above, some of the common issues in tracking, fixing and resolving common claim, encounter and enrollment processing issues is painless with T-Connect. Powerful and complete EDI parsing and validation, alongside tracking and editing tools lower the day-to-day overhead inherent in managing complex healthcare workflows.


 

To begin a conversation with Tallan and see T-Connect in action, contact us today to discuss how we can improve your EDI management capabilities.

 

Tags: edi, T-Connect, tallan, x12,

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