EDI in healthcare: Nitor Capabilities
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Transcript of EDI in healthcare: Nitor Capabilities
EDI In Healthcare:
Nitor Capabilities
EDI service landscape
834 – Insurance eligibility and benefit verification Paper based claims submission – UC05, CMS1500
837 - Claims information 835 – Remittance advice
999 - Acknowledgment
Generation and verification of EDI 837P and EDI 837I file from flat file
Parsing EDI 835 file and converting it to simple readable flat file
Conversion from flat file to EDI format
To map data from flat file to EDI format
Report generation
Healthcare domain
knowledge
Business Intelligence &
Analytics
Product Engineering Mobility
Healthcare testing
En
gag
em
en
tA
cti
vit
ies
ED
I
Nitor’s capabilities in EDI transition
iOS App• Generating EDI 837P and EDI 837I file from flat file received from various providers
to be submitted to payer
• Parsing EDI 835 file received from payer and converting it to simple readable flat file and entering the same in database so that reports could be generated easily
• Generating EDI 834 file and sending the same to the payer for benefit and eligibility verification
• Support conversion of messages between many different formats, such as, X12, EDIFACT, XML, Proprietary formats (SAP IDOCs, JDE formats, etc) and also map directly to Databases
• Convert flat file data into EDI format
• Parse the EDI file received in desired format like flat file, .doc etc
• Map data from flat file to EDI format
Data handshake during development: Masking for Compliant Engagement
• Masking PHI data to maintain confidentiality• Maintaining Audit compliance – To maintain user wise for data
accessed, data shared, login time, logout time etc)
We need data for testing
/execution
Because of HIPAA, you can
not provide us with REAL
data
Data can not cross
US boundary
Nitor Provides
you “MASKER”
You MASK data at
your place
You make the data –
“non-decipherab
le”
Nitor gets Data for testing
that can not be
IDENTIFIED
Compliant Engagement
Services and
Capabilities
• Secure interoperability while sharing sensitive data• Copy sensitive data outside your production environments
• Move your development to the cloud or offshore• Need regulatory or audit compliance (i.e.- HIPAA, Dodd-Frank)• Interoperability among ACO & HIE participants