Search Results for "Tallan Partner"

Rapid EDI Trading Partner Onboarding with T-Connect

HIPAA X12 EDI transmission between the many entities in the HealthCare industry is performed using files conforming to ANSI X12 specifications. These Claim, Premium Payment and Remittance Advice EDI files may originate from payers, providers, clearinghouses, or third party administrators (TPAs). One prevalent hurdle in sending or receiving these EDI transactions is the often complex onboarding process of new trading partners.
HIPAA EDI files in X12 format may typically look similar to the sample below.

Dell Boomi X12 Trading Partner Feature Overview

The Dell Boomi AtomSphere provides users with the ability to create and configure trading partners for EDI transactions. Users can create trading partners to be used with the X12 Interchange format.
The X12 Interchange Format is a standard used for the sending and receiving of EDI files, it allows us to define different pieces of information about the file and communicate information about what is expected of the file between the respective trading partners. It uses the ISA and GS segment definition headers within sent EDI messages to set this information.
This post will cover how to create a basic X12 Trading Partner and the different configuration options available for them.
First we can create our trading partner by creating a new component and selecting “Trading Partner”, we can configure items such as the name and whether or not this is our company…

Migrating SQL Server Reporting Services (SSRS)

For most Microsoft IT professionals, migrating or updating a native mode SQL Server Reporting Services (SSRS) installation from one version to another is a rare, if not once-in-a-lifetime, event – and probably one you would prefer a root canal to.  Because software upgrades of all types tend to get postponed as long as possible, if you find yourself finally tasked with such an upgrade, several unpleasant things are likely true:

The effort is in crisis mode, driven by software (SSRS, OS) going off support, hardware becoming unreliable, or a line-of-business application that must itself be upgraded but cannot be until SSRS is.
The current installation was not done by you and whomever did is long gone, so you are not that familiar with it and would frankly rather not be. SSRS is not your “thing”.
The current installation is poorly documented, if at…

Talk UX 2018 Recap

Talk UX is an annual design and technology conference hosted by Ladies that UX Boston (LTUX). LTUX is a global organization that has created an international community of supportive and inspiring women in design and technology.
This year’s conference was held at the beautiful Joseph B. Martin Conference Center at Harvard Medical School. There were roughly 500 people following a single stream of presentations and discussion panels by women in leadership. UX leaders, designers and researchers as well as professionals not actively working in UX attended this event.

The Talks
 
Building Bridges Through UX Research
Laura Granka – Director of UX Google
Slides | Video
Laura described some methods that Google uses to stay true to their user-centered strategy. One method she talked about was Google’s immersion studies, in which product teams go to the users. Per Laura’s suggestion, Google fashioned a 15 passenger van into a usability lab to…

Chatbots Get One Step Closer to Direct to Consumer with Google’s Adlingo

By now it should be readily apparent that Chatbots have become the new normal when it comes to must-have technologies for companies. From customer service to retail, Chatbots have been saturating every aspect of our business. One such area that has seen a huge uptick in activity has been in the area of digital advertising.
Companies such as Revlon and Coca-Cola have been tapping into the power of Chatbots in order to help create campaigns around new products. The advantages of this type of campaign are that companies are able to extract much more data from the consumer by utilizing a chat-like interface. This opens the door to a whole new area of analytics with things like keyword extraction and sentiment analysis. In addition, Chatbots are able to pivot the conversation around specific things that the consumer has said and thus…

SNIP 6 – Line of Service or Product

What are HIPAA SNIP types? We get this question a lot, so we’ve been blogging about the different categories WEDI has defined to validate healthcare EDI transactions. Thus far, we’ve covered:

SNIP 1 & 2 Integrity and Requirement Testing
SNIP 3 Claim Balancing
SNIP 3 Remittance Advice Balancing
SNIP 4 Intersegment Situational Testing
SNIP 5 External Code Set Testing

These rules are sometimes referred to as SNIP levels – although that may wrongly imply that each type builds upon the previous category. In actuality, each SNIP type is a standalone set of validations rules.
In this article, we’ll focus on SNIP 6.
Type 6
SNIP 6 enforces situational rules specific to service lines and products. While SNIP 4 also focuses on situational rules that analyze the relationships between loops, segments and elements, SNIP 6 differs in that the rules apply to subsets within the transaction sets.
For example, within an 837…

SNIP 4 – EDI Intersegment Situational Rules

WEDI SNIP Types define sets of rules for validating EDI transactions such as 837 claims, 834 enrollments or 835 Remittance Advice.
Previously, we’ve blogged about:

SNIP 1 & 2 Integrity and Requirement Testing
SNIP 3 Claim Balancing
SNIP 3 Remittance Advice Balancing
SNIP 5 External Code Set Testing

This article focus on SNIP 4, which test situational rules spanning separate loops, segments, or elements. What differentiates these rules from Type 2 is that the situational tests span distinct segments, while Type 2 is considered intrasegment testing. Intrasegment tests validate the presence of elements within the same segment based on syntax rules.
Type 4
SNIP 4 situational rules break into two categories. Both categories consist of a condition statement, then a data item (loop, segment, or element) which should (or should not) be present based on the rule evaluation.
Category 1
The first category of situational rules specifies that sending the specified data item is up…

SNIP 5 – HIPAA External Code Set Testing

The HIPAA X12 EDI specification allows for the inclusion of code values that may be pertinent to the transaction set, such as a claim or encounter. These code values can represent a data point as widespread as a postal or zip code, or as complex as diagnosis and procedure codes.
WEDI describes seven types of validation, referred to as SNIP 1-7, as covered in some of our previous blog posts on SNIP 3 Balancing of Claims and Payments. SNIP 5 – HIPAA External Code Set Testing is the validation of code values against the external code sets they represent.
SNIP 5
As previously stated, SNIP 5 validates that code value exists within an external code list. For example, if a postal (zip) code is present in a subscriber’s address, then it should align with an actual postal code in as determined by the USPS, the…

Submitting Workers Compensation Claims as 837s

Workers compensation claims contain a special set of requirements when submitted in the EDI 837 format. This article describes these specific characteristics.

In a standard 837, the 2000B loop always contains subscriber information (the primary insured individual). Claim level information (2300 loop) is nested beneath the 2000B loop in this scenario. The 2000C (Patient) loop is present in the case in which the claim is related to a dependent of the subscriber. In these cases, the 2300 loop is nested under 2000C. In workers comp claims, a 2000B and 2000C loop always exist, and their purposes are a bit different. Information related to the employer goes into the 2000B loop, while the 2000C loop is used for the claimant (the injured worker). The concept of a dependent doesn’t exist in workers comp claims.

The SBR segment present in 2000B is a required…

CAQH CORE Certification Tips

CAQH CORE certification demonstrates that health plans, clearinghouses and software vendors meet federally mandated operating rules when exchanging HIPAA EDI transactions. Internally for organizations, the certification process provides value by exercising a broad variety of test cases. Last but not least, CORE specifies the message envelope details for exchanging EDI over two types of HTTP endpoints, reducing the implementation times that custom message formats can incur.
The CAQH website is the complete resource for understanding the types and variations of CORE certification. In this article, we’ll take a complementary approach. Rather than attempt to summarize the full spectrum of options, we’ll focus on a single use case in order to highlight key information and technical challenges. Tallan’s T-Connect Eligibility Module places us in the software vendor category. Our EDI management solution enables health plans to act as an information source to respond to 270 Eligibility requests with a…

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