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Posts Tagged "edi"

EDI: Still Essential After All These Years

Tallan Partner

Back in 2011, Gartner analyst Benoit Lheureux wrote a blog post titled: “EDI is Hot, No, Really!”
That was probably stretching it then and six years later…well, let’s just say “hot” is perhaps overstating it. But there’s no overstating the continued importance of EDI to many businesses.
“Bottom line: EDI remains — and will remain for years to come — a high impact, valuable asset to business,” Lheureux wrote in his report. “… EDI is a well-established approach that is still a vital component of most companies’ overall B2B strategy and easily contributes to B2B, cloud computing, business intelligence, et al.”
Like the Internet, EDI has its roots in the military. The scale and complexity of the 1948 Berlin airlift required the exchange of information about transported goods—over a 300-baud teletype modem, no less. The effort led to standards that eventually became EDI as…

Dell Boomi X12 Trading Partner Feature Overview

Mike Agnew

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…

B2B Challenges in Healthcare

Tallan Partner

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…

Enhanced QNXT Integration – EDI Transformation and Tracking

TriZetto’s QNXT is a widely adopted platform for claim processing and membership administration. QNXT relies on the Microsoft stack, particularly BizTalk, .Net and SQL Server, to process and store EDI messages.
These technologies give developers many tools for customizing and tracking HIPAA transactions, but the complexity of implementing business rules and lifecycle reporting on EDI data are constant concerns for health plan payers.
Tallan’s T-Connect EDI Management Platform is an optimized integration solution founded on three core design principles:

An accessible API. One of the most common challenges our partners face is implementing business logic on EDI. T-Connect loads all HIPAA transactions into a fully compliant hierarchical data structure that can be manipulated with familiar tools such as Visual Studio and .Net.
Full database persistence. Going from EDI to a relational database is a frequent business need, but capturing the full set of fields present in an 837 alone represents…

Considerations About HL7 Integration

On the provider side of healthcare integration, HL7 (particularly v2) is a critical message type to understand. While it is standardized and heavily used by various EHRs/EMRs, it’s used in slightly different ways. There are efforts to further standardize and normalize its use across the board (such as with v3/FHIR), many EHRs and EMRs continue to use 2.x messages.  Common HL7 messages include admissions/transfer/discharge (ADT), scheduling (SIU), lab orders and results (ORU, ORM), and medical reports (MDM).  Choosing the right platform can be challenging.
Some of the challenges of HL7 2.x messages include:

The ability to add non-standard custom segments or additional data anywhere in the message (whether they are completely custom “Z Segments” or other segments that aren’t typically part of the message, such as IN1 segments in an ADT message to include additional insurance information).
A myriad of parsing and manipulation libraries…

Why the Healthcare Industry is Utilizing EDI as the Standard in Managing Increased Enrollment and Regulation

Gabriel Gomez

Over the past few years, the healthcare industry has undergone a complete overhaul of how it processes information. This was brought about by a growing list of new and complicated regulations handed down by federal and state governments that stem from the Healthcare Insurance Portability and Accountability Act (HIPAA) and the Patient Protection and Affordable Care Act (ACA), designed to improve the efficiency and effectiveness of the industry. These regulations include standardization of the electronic transmission of Electronic Data Interchange (EDI), which also protect the security and privacy of electronically transmitted information provided by their patients.
These mandates created an immediate challenge to healthcare organizations, because it required the industry to take increased ownership and control of Electronic Health Records (EHR). In order to meet this demand quickly, healthcare providers scramble to leverage a variety of methods to manage their EDI…

EDI and Dell Boomi – Part 2

Mike Agnew

In our last post we were able to import an EDI Profile using Dell Boomi’s built in tools and we learned a little bit about how Boomi processes EDI. This time we will be modifying our 810 profile with some custom fields that our “business” requires.
From last time, the file we’re working with for this sample looks like this:
We already have a profile that can handle the input of this file, but let’s say one of our department heads just notified us they would like to keep track of the type of truck the order an invoice was for was driven on.
We’ll say that information in our file will look something like this:
Let’s add this segment below our N1 Loop in the Header Loop, we’ll say that this information is static for an entire invoice so it makes sense to…

EDI and Dell Boomi – Part 1

Mike Agnew

Dell Boomi is a cloud-based integration platform with many capabilities, EDI being no exception.
EDI stands for Electronic Data Interchange, which is a method to communicate data across various platforms and technologies. It provides a very versatile way to send data such as order and healthcare information very quickly in a standardized way. This standardization comes from the many EDI file types which exist. These file types are denoted by their respective numbers. For example, an 810 file is used to represent an Invoice.
EDI Files can be intimidating at first glance, but once you understand some basic syntax they become logical to read. For example, here’s a very small 810 Invoice file below:
Each line in the file is called a “Segment”. Within each segment there are numerous “Elements”, each element is separated by an “Element Delimiter”. In the case of our…

T-Connect EDI Accelerator and EDI Viewer Updates are Available Now!

Kevin Morillo

This month we are happy to announce new versions of a few of our products adding additional features and capabilities.
First, we have updated our T-Connect EDI Database to support the full ANSI X12 EDI 837 transaction set.  This includes full support for Institutional, Professional, and Dental transaction sets.  The EDI Database Toolkit is our proprietary set of databases constructed to store and archive EDI messages and is included in our EDI Accelerator package, or can be purchased as a standalone product.
We have a new version of our T-Connect HIPAA EDI Accelerator available.  The EDI Accelerator is our flagship product allowing for rapid deployment of a complete end to end EDI intake and storage solution based on the Microsoft BizTalk Server platform.

The T-Connect EDI Viewer has been updated with backwards compatibility for the EDI ANSI Version 4 (004010).  The EDI…

Working with HIPAA Professional Claim (837P) Messages in BizTalk (Part2)

Dan Field

In the last post, I wrote about the overall structure of 837P claim messages.  837I and 837D messages have similar structures, though with some differences – for example, the 837I has many more diagnosis code options, and the 837D has more specific nodes for tooth identification, etc.  One important thing to note is that 837P, 837I, and 837D files are very similar, but not the same.  It’s not enough to simply change the version numbers in the GS and ST segments and then try to process one the same as the other!  If it were that easy, we wouldn’t need separate schemas for them in BizTalk!
BizTalk provides out of the box functionality to support these message types, with well developed functionality to translate the X12 EDI to XML and vice versa.  The schema nodes also have friendly names, translating something like this:
NM1*IL*1*Field*Dan****MI*123456789~
To…

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