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,…
The Customer Data and Analytics (CDnA) team at Microsoft enables strategic data insights that shape the entire organization, from high-level leadership policies to small product decisions. At its core, CDnA creates and monitors indicators, known as “Power Metrics,” for some of the key divisions and businesses in Microsoft. CDnA delivers Power BI dashboards to several teams, including the Windows and Devices Group (WDG), Office, Bing, Cortana and Microsoft CEO Satya Nadella’s Senior Leadership Team (SLT). The SLT leverages the Power BI dashboards to monitor progress on strategic initiatives at the company.
Both CDnA and the Power BI product have mutually benefited from a close relationship since the Power BI public preview in 2015. In fact, the early and ongoing input from this internal Microsoft team and its users has helped make Power BI the “enterprise ready”, robust, and feature-rich platform it…
Seattle Reign players, coaches and staff celebrate a win over the Portland Thorns.
Sports ignite peoples’ passion like nothing else. Standout athletes become legends through their performance on the field. But what sets them apart often comes down to decisions made off the field, such as diet, mental and physical preparation and the frequency or intensity of practice. The difference between a win or a loss can be decided by an extra five minutes of wind sprints, levels of hydration or getting to bed 30 minutes earlier the night before.
At Microsoft, they believe sports provide a tremendous opportunity to use technology to transform how individual athletes and teams push the limits and gain the edge they’re looking for in the most challenging of circumstances. Imagine making clutch decisions that are based on insight, rather than gut. And what if coaches could…
For reliability, accuracy and performance, both AI and machine learning heavily rely on large sets. Because the larger the pool of data, the better you can train the models. That’s why it’s critical for big data platforms to efficiently work with different data streams and systems, regardless of the structure of the data (or lack thereof), data velocity or volume.
However, that’s easier said than done.
Today every big data platform faces these systemic challenges:
Compute / Storage Overlap: Traditionally, compute and storage were never delineated. As data volumes grew, you had to invest in compute as well as storage.
Non-Uniform Access of Data: Over the years, too much dependency on business operations and applications have led companies to acquire, ingest and store data in different physical systems like file systems, databases and data warehouses (e.g. SQL Server or Oracle), big data systems (e.g….
The Associated Press delivers 2017 Virginia gubernatorial primary results with Microsoft Power BI publish to web.
For more than 170 years, The Associated Press (AP) has told the world’s biggest and most important stories, from the assassination of Abraham Lincoln to the fall of the Berlin Wall, and more recently Brexit and the 2016 U.S. presidential election.
Today, when news is frequently accompanied by massive quantities of data, reporting means making sense of all that data, and AP continues to lead the way in data journalism. The news agency, with locations in more than 100 countries, provides newsrooms worldwide with data-driven reporting on everything from politics, business, environmental science and public safety to sports, education and more. Recent AP data journalism efforts uncovered water quality issues in public and private water systems, analyzed the history of refugees from the seven countries included…
Efficient data management keeps goods flowing smoothly in Denmark. Danske Fragtmaend, the country’s largest national transport and distribution firm, has been moving freight for more than a century. Today, Danske Fragtmaend delivers more than 40,000 consignments each day throughout Denmark, and businesses from small mom-and-pop operations to factories rely on its services.
The firm handles logistics in a central location, where 200 dispatchers keep an eye on the movement of thousands of trucks and their cargo. Both drivers and dispatchers need the latest information to operate efficiently, so they rely on a data platform based on SQL Server 2016. The storage system includes 160 terabytes of flash memory for fast I/O and high uptimes. Throughout the day, drivers continually scan transactions with PDAs and send shipping information including GPS coordinates to the data platform. Fast access to information is essential. Ulf…
Power BI was first made generally available in July 2015. Since then, Microsoft’s driving vision for Power BI has been to enable users across roles, disciplines and industries to sign up for the service in seconds and get business value by drawing insights from their data within minutes. Microsoft’s relentless focus to drive access to insights at scale has helped Power BI reach more than 200,000 organizations, and the breadth of this global community continues to directly contribute to Power BI’s evolution – to date more than 400 features have been added to the service as the result of input from more than 50,000 users.
Introducing Power BI Premium
Today Microsoft is taking the next step in its commitment to empower people and organizations with access to critical intelligence: introducing Power BI Premium. Power BI Premium builds on the existing Power BI…
1: Build data-driven apps that learn and adapt
Applications show intelligence when they can spot trends, react to events, predict outcomes or recommend choices—often leading to richer customer experiences, improved business process, or addressing issues before they arise. The three key ingredients to creating an intelligent app are:
Ingest data in real time
Query across historical and real-time data
Analyze patterns and make predictions with machine learning
With Azure, you can make your applications intelligent by establishing feedback loops, and applying big data and machine learning techniques to classify, predict, or otherwise analyze explicit and implicit signals. Today, apps for consumers and enterprises can deliver greater customer or business benefit by learning from user behavior and other signals.
Pier 1 Imports launched a mobile-friendly pier1.com, making shopping online easier. It enabled the selection of delivery options like direct shipment, picking up products in the local store,…
Upgrading your software can be daunting, Microsoft knows. The fast pace of business makes it easy to tell yourself, “I’ll do it later when I have time.” Microsoft gets it! But here are five key reasons to make time to upgrade to SQL Server 2016, which was named DBMS of the Year in 2016 by DBengines.com.
Seamless step-up without rewriting apps. Thanks to November’s SQL Server 2016 Service Pack 1 (SP1), SQL Server now has one programming surface across all editions. If you switch from Express to Standard, or Standard to Enterprise, you don’t have to rework code to take advantage of additional features. Time saved! In addition, the change brings access to innovative features across performance, security, and analytics not previously available in Express or Standard—a great reason to upgrade applications that run on those editions. The Enterprise edition of…