The X12 HIPAA transaction set is used across the healthcare industry to transmit claim, enrollment and payment information. Given the importance and ubiquity of these EDI files, you might assume that translating them from ANSI to a relational database format would be well-supported with a range of options.
In practice, a task as common as parsing a claim or encounter and storing it in a database can quickly escalate into a significant problem.
One solution we’ve seen involves archiving a snapshot of the EDI file using filestream storage. This can satisfy some retention requirements, but provides little in terms of fine-grained tracking or analytic capabilities.
A more complete approach is to parse the X12 file into its discrete elements and store them in a relational database. The ideal solution captures the full extent of the EDI transactions while also applying a reasonable leveling of flattening to keep in the number of table joins under control.
835 and 837 EDI transactions have transformed the adjudication cycle for providers and health plans over the last two decades, but challenges remain in reconciling payments with claims. Today we’ll focus on the 835 Claim Payment/Remittance Advice. Health plans submit 835s to providers (or their intermediaries) to explain which claims are being paid, and any reductions to the submitted amount and the reasoning for the adjustment. This is an important function – a significant pain point experienced by providers is the reconciliation of their income against claims submitted.
Before this valuable information can be loaded in practice management software, the 835 should pass validation checks. Common issues affecting 835s are balancing errors between the header and detail payment amounts. Imbalanced 835s lower the quality of reporting and can lead to billing errors and lost revenue.
WEDI describes up to seven levels of validation,…
BizTalk360 is a browser-based monitoring application for Microsoft’s BizTalk integration platform. The out-of-the-box monitoring functionality can be difficult to navigate both for new users and experienced admins, and is complex and time consuming to set up for multiple users with varying access rights. BizTalk360 combines the Admin Console and Event Log, with some added analytical and notification functionality, to create an easy to navigate operational tool.
In this overview of basic BizTalk360 setup, I will assume you have a BizTalk application already deployed that contains at least one receive port and send port. Although there is a huge amount of configuration and monitoring that can be done through BizTalk360, this article will focus on initial configuration and simple environment health monitoring.
One of the great new additions of the recently released Feature Pack 1 for Microsoft BizTalk 2016 is a REST API, which can be used to administer BizTalk Server. Longtime users of BizTalk may have experience with using ExplorerOM.dll or WMI based scripts to manage their BizTalk environment. The REST API introduced in Feature Pack 1 provides a more flexible alternative, including a Swagger definition providing rapid implementation of an application to consume the API. In this post, I will walk through the process of installing the API as well as using Swagger to generate a C# client and demonstrating a simple command.
There are many situations where we need to deploy WCF Services that we can use to interact with BizTalk, but if you’re constantly deploying to new systems, the process of manually creating and configuring them can become very time consuming and tedious. Leveraging the abilities of the BizTalk Deployment Framework (BTDF) we can automate this process along with your typical BTDF deployment.
In this guide we’ll step through how to configure BTDF to build the deployment of our existing WCF Services into the installer which BTDF creates for deployments.
In order to follow this guide it’s assumed that you have the following prerequisites:
A BizTalk solution and environment with BTDF installed
Already deployed WCF Services which you wish to replicate via deployment on the same machine
A basic knowledge of BizTalk, WCF, and IIS
First up we need to move our services into our solution folder. Simply…
Microsoft has provided us a lot of nifty new features with BizTalk 2016, and among them are a few different ways to control the various application settings while importing and exporting applications. We’ve discussed some of these new additions in a previous post, but today we’ll talk about a new checkbox which allows us to control whether or not the tracking settings will be imported.
In a previous blog, we discussed a number of new features that were added to the admin console with the release of BizTalk 2016. This new release has provided users with a number of helpful features, and among them is the ability to import and export parties separately from applications.
Last week Microsoft released a new version of BizTalk, and they’ve added some exciting new features. A comprehensive list of changes has been provided by Microsoft here, but we’ll take a closer look at a few of the changes in the admin console which make life a lot easier for BizTalk users.
If there’s one problem that an integration system needs to address, it’s standardizing the format of all data being exchanged. Before any type of data can be processed or transformed, the system handling it must be aware of its format and structure. Using a service, at the client endpoint, forces the user to provide proper data that is agreed upon. This acts as a contract between the service and the client. Given a certain format of data, the client will receive another format of data in return. Anything that happens behind the curtain is the responsibility of the service; the client simply waits for the returned data set.
BizTalk WCF Service Publishing Wizard
One of the more popular tools offered by BizTalk 2010 is the WCF Service Publishing Wizard. This handy tool can automatically create a WCF service, and fully configures the…
SWIFT – or the Society for Worldwide Interbank Financial Telecommunication – is the main global provider for secure messaging in financial transactions. The standard they created and currently maintain is utilized by hundreds of banks throughout the world. Today we’re going to go through a quick tutorial for getting set up with A4SWIFT, BizTalk’s SWIFT messaging accelerator for speeding up integration with this platform.