HealthCare

Redix International, Inc. has an HIPAA/EDI package dedicated to the HealthCare industry.  This package includes the following:

• Redix AnyToAny Format Converter Engine
  
• Redix Format Converter GUI Mapper with Authoring Tools
  
• HIPAA database, which incorporates all the HIPAA (Health Insurance Portability and Accountability Act) transaction sets: 
  
  • 270/271: Health Care Eligibility/Benefit Inquiry and Information Response
     
  • 275: Patient Information
    
  • 276/277: Health Care Claim Status Request and Response
    
  • 278: Health Care Services Review -- Request for Review and Response
     
  • 820: Payment Order/Remittance Advice
    
  • 834: Benefit Enrollment and Maintenance
    
  • 835: Health Care Claim Payment/Advice
    
  • 837: Health Care Claim: Institutional
    
  • 837: Health Care Claim: Dental
    
  • 837: Health Care Claim: Professional
    
    
• Supports Six Levels of Testing recommended by WEDI/SNIP.
   
• Supports version 4010, 4020, and 4030 X12 databases
   
• Supports the HIPAA syntax rules and code definitions
  
• HCFA (Health Care Financing Administration) databases, which includes the NSF Version 2.0 and 3.1, and the UB92 standard Version 5.0 and 6.0
  
• Pre-defined maps between the HIPAA Professional Transaction Set and the HCFA NSF standard
  
                  HIPAA 837 Professional to NSF 3.1
                  NSF 3.1 to HIPAA 837 Professional
  
                  HIPAA 837 Professional to HCFA 1500 Form
                  HCFA 1500 Text Image File to HIPAA 837 Professional
   
• Pre-defined maps between the HIPAA Institutional Transaction Set and the HCFA UB92 standard
  
                  UB92 5.0/6.0 to HIPAA 837 Institutional
                  HIPAA 837 Institutional to UB92 5.0/6.0
  
                  HIPAA 837 Institutional to HCFA UB92 (1450) Form
   
• The proprietary UB92 format, such as the state specific Medicare/Medicaid UB92, is also mapped to a HIPAA 837 transaction set in a pre-defined map.
   
• Pre-defined maps between the Interactive Eligibility Request (IHCEBI) and the HIPAA 270 Transaction Set
  
• Pre-defined maps between the Interactive Eligibility Response (IHCEBR) and the HIPAA 271 Transaction Set
   
• With RMAP Module, each HIPAA transaction can be converted to a CSV (Common Separator Value) file.
  
  Additional Information:
  
• The Converter engine is available in both the Windows and UNIX platforms.  UNIX platforms include AIX, DEC UNIX, Sun Solaris, SVR4, and the HP-UX operating systems.
  
• All the pre-defined maps can be cloned and modified to accommodate the user's requirements. 
  
• View the translations simultaneously, while performing drag-and-drop operations between two tree structures.
  
• This HealthCare package consists of complete map reports with sorting capabilities.
  
• This HealthCare package can generate Interface statements in Visual Basic, C++/C, or JAVA.
• With the optional Redix XML module, the Redix XML HIPAA package can automatically generate a HIPAA DTD or W3C Schema.
   
• The Redix HIPAA package with database module provides a pre-defined map, which converts the HIPAA 837 transaction set to a Microsoft SQL Server database; then in a separate pre-defined map, the data is extracted from the SQL Server and re-formulated into a HIPAA 837 message.
   
• Benchmark results of the Redix HIPAA package can be found here.

You can view the presentation material made by Dr. Pen Chiang and Randall King on the conference of " E-Commerce and HealthCare: The Final Frontier". The conference was sponsored by DISA and HIBCC on Oct. 28-30, 1998 at Chicago.

XML Repository
Redix has an XML repository for the healthcare claims, which is not included in this package. Several pre-defined maps have already been built using the XML repository.  These pre-defined maps include the XML to NSF standard, XML to UB92 standard, and the XML to X12 standard maps.