Tallan Blog

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

Category Archive for "Healthcare"

Poll Results Part II: Microsoft Healthcare Bot Webinar: Enabling and Enhancing Patient Engagement

You might have seen our post last week, Poll Results Part I: Microsoft Healthcare Bot Webinar: Enabling and Enhancing Patient Engagement.
If you have, I’m sure you’re absolutely chomping at the bit to find out how people answered the question at the end of the event.  Well, the answer options differ a bit based on the use-cases from Quest Diagnostics and Aurora Health Care.
This poll occurred after the presentation from Microsoft Health Care’s Adam Walker, and Tallan’s own Matt Kruczek. Adam spent time on the details the team focused on to ensure the Bot would be compliant and useful for the healthcare community (to include a built-in understanding of medical language). While Matt elaborated on 3 of the pilot programs.  One assists with triaging and symptom checking patients, one focuses on follow-up and discharge plan adherence, and the other centers on…

Poll Results Part I: Microsoft Healthcare Bot Webinar: Enabling and Enhancing Patient Engagement

Earlier this month, we partnered with Microsoft and hosted a live webinar focused on the new Healthcare Bot platform. The Product Lead from Microsoft Healthcare lent his time to Tallan to speak to the production of the framework for this Chatbot, while Tallan’s AI team discussed 3 cases where this Bot is already being used to benefit patient engagement.
In short, this Healthcare Bot Framework, as opposed to Microsoft’s traditional Bot Framework, was specifically created with Healthcare compliance laws in mind, and an understanding of “healthcare intents by leveraging built-in language models tuned to medical terminology.”
Because Conversational AI is still very much making a name for itself as a mainstream tool, we polled our audience at the beginning of the webinar, and the end.
The first question was focused on patient engagement challenges, specifically what they face at their organizations.  Our audience…

1500 form Editor

How to Access the Online Fillable CMS-1500 Claim Form on X12 Hero

In this blog we provide instructions on downloading a free CMS-1500 form. Since we’ll be using the Claim Form Editor Web-App on X12 Hero the CMS form is enhanced by our EDI validation software. X12 Hero offers a SaaS subscription for access to a full collection of healthcare EDI and medical billing web-apps. With this 1500 form we can easily enter claims and check completed claims for entry errors. We’ve found that pre-validating your claims in X12 Hero results in an 80% or better first pass acceptance rate. We’ll discuss how to resolve these errors that could otherwise result in a denied claim. The application also has the capability to convert CMS 1500 forms to EDI 837p files for submission. This blog gives simple steps for you to get started and improve your medical billing efficiency.
How to Use the Fillable…

CMS

First Look: Microsoft Healthcare Bot

On February 7th, 2019, Microsoft announced the availability of a new SaaS chatbot offering designed for use in the healthcare industry.  They designed it to be a very fast-to-market conversational AI with built-in healthcare language models, terminology, and be compliant with security standards in the industry (HIPAA, ISO 27001, ISO 27018, CSA Gold, GDPR).
Mid-March I began my exploration into this offering and started building my first “Scenario.”  Once you have created a bot, you are delivered to a new portal and are quickly presented with a showing of pre-baked templates for you to modify and make your own. At the time there were three available and four listed as coming soon.

I decided to start with the Provider Lookup scenario.  Once I created the scenario, I was then taken to a well-designed CMS tool for building it.  The tool displays the…

Generate HIPAA EDI Testing Files – 4 Easy Steps!

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.
X12 Studio EDI Toolbox is an EDI development toolkit (available as a free trial download) 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 Generator”…

Splitting 835 Healthcare Claim Payment

The Electronic Data Interchange (EDI) consists of a file in a specific format that represents data exchanged in a transaction from supply chain to healthcare. EDI 835 Claim Payment transaction provides payments information in reference to claims in EDI 837 Healthcare Claim format. The details include transactions such as charges, deductible, copay, payers, payee, etc. The information is stored a hierarchical structure. The standard of EDI format is well defined and the complexity can be very overwhelming. Additionally, we do not want this high degree of detail slowing our processing time.
One of the problems that enterprise systems face with EDI is file size. A single EDI 835 may contain multiple claim records and the quantity of claims in a single file can make it very difficult to process the file. Systems are often bogged down when dealing with a very…

X12 EDI Databases for HIPAA Transactions

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.
The…

Top 3 Trends Impacting Healthcare Payers

Healthcare is one of the most important factors in how individuals perceive their quality of life.i But quality health care comes at a price and precious healthcare funding is being lost to fraud, waste and abuse (FWA). In fact, an estimated $455 billion in global healthcare spending is lost every year – ultimately leading to lower quality care and higher premiums and taxes.ii
Everyone plays a role in combatting FWA, but healthcare payers are on the front lines. Recently, three major trends emerged that present an opportunity for healthcare payers to play a major role in combating FWA. Let’s take a look at the way these trends are changing the healthcare landscape.
1. Plenty of healthcare data, not enough insights
Healthcare executives would like to leverage big data, but only a few are able to gain EDI data insights and visibility needed to garner…

Setting Verbose mode for a Boomi Process using Dynamic Process Property

Setting Verbose mode for a Boomi Process using a Dynamic Process Property
In most instances developers will have to accommodate certain reporting, notification and logging requirements of a given interface within the Dell Boomi AtomSphere platform.
Often times, the logging or emailing may need to be disabled for testing and/or faster iterative cycling through test cases and, of course, to not annoy the user community with email test messages.
The most straightforward way to accomplish or implement a verbose or Test Mode Boolean flag (as is very common in other platforms) is to create and enable a Dynamic Process Property and then assign its default value while allowing to reassign the same with extensions directly after deployment.

B2B Challenges in Healthcare

It’s no secret that paying for healthcare in the United States is extremely difficult to do. Payment systems for healthcare across the country are highly fragmented; many payers and providers use multiple formats for remittance. This creates challenges and frustration for patients, providers, and insurance companies, particularly at a time when there is increased pressure to reduce costs. Other industries use B2B automation processes in standard languages like EDI to standardize and automate payment systems; B2B challenges abound for the healthcare industry.
The B2B challenge in healthcare remittances
Thanks to the Affordable Care Act, there are now in motion some new initiatives related to healthcare payment reform – chief among them, the transition from fee-for-service to value-based care.  “The ramifications of this transition for payers are significant,” says John Tyler, Data Science Platform Manager at Premera Blue Cross. “Payers are going to…

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