Solutions Video Podcasts

Solutions Topics

SoftCare "Turnkey" EDI Solutions for HIPAA EDI

SoftCare EC, Inc. has been developing and deploying e-Business solutions since 1989. SoftCare’s staff has extensive experience providing feasibility, planning, implementation assistance, compliance certification, software, consulting, and professional services. Our Turn-Key best practices for successful e-Business are based on the 1000’s of successful trading partner implementation, integration and support projects over the years....

HIPAA EDI Solution Quickstart for Healthcare

HIPAA EDI - The first approaches to implementation were published in mid-August 2001 that stated that all doctors, hospitals, health plans, and clearinghouses will begin to start implementing the new federal Electronic Data Interchange (EDI) standards. All Healthcare data transmissions must adhere to these standards, but the required security standards have, by far, the most wide-ranging impact on the industry. These mandated HIPAA standards are having a significant impact on the entire Healthcare industry. The key thing to remember is that insurance companies will shoulder the majority of the burden of compliance to HIPAA as they must convert their systems to accept and implement these changes." ...

HIPAA EDI Version 5010, The Coming Tsunami

The current 004010 standard is widely recognized as outdated and lacking in the functionality currently needed by the industry. The Version 5010 final rule will correct the outdated transaction standard and enhance administrative data exchanges. Version 005010 will be less complicated to implement than the original 004010 since 005010 is the refinement of this existing standard and implementation will not be from “scratch.” Some transactions within the code set have changed very little, but others, such as 837 claim transactions, have significant changes. It is important to understand that Version 5010 adds new functionality designed to provide benefit and will not include code set values that are no longer necessary to accomplish the business activities.

EDI 270 & 271 Electronic Patient Eligibility,  The "Killer App" for HealthCare?

We at SoftCare Healthcare believe that Electronic Patient Eligibility is the “Killer App” in Healthcare as finding out a patient’s insurance eligibility is the key first step in the implementation of a successful e-business strategy for Healthcare. Electronic Patient Eligibility allows a provider:...

EDI 834 Enrolment.  The TPA's biggest bank for the buck?

Imagine that you are an ERISA Enrollment TPA whose mission is to offer a comprehensive, integrated benefits administration services, simplifying benefits administration within the human resources department by acting as a central resource to take care of all of an employers benefit administration needs. To fulfill this mission, you need technology and business process to manage the benefits process for a large number of your clients. You have seen a lot of changes in benefits administration since you started. Early online solutions were designed to eliminate paperwork and streamline processes in the human resources department. Today, benefits management companies must constantly adapt to ever changing business requirements when providing benefits management to a wide variety of employers. As they are focused exclusively on benefit management, they have developed sophisticated systems and solutions to manage the benefit process for multiple employers to multiple insurance carriers 

EDI 835 Payment Advise,  The road to automatic payment reconciliation ?

Imagine that you are a clinic administrator and you are in charge of claims processing for the entire clinic. You have thousands of outstanding claims and you need to know when you get paid, which claim that you are being paid for and why some claims aren’t being paid in full. Today, you get a weekly paper report on claims paid but it is a manual process to reconcile the payment to your financial and claims management system. Wouldn’t it be great if this information could automatically flow into your systems so that you can review them and focus only on problem claims?

EDI 278 Coordination of Benefits,  Know the Benefit ...

Imagine that you are at the dentist and you need a new crown put on a troublesome tooth. In the old days, your doctor would accumulate the appropriate paper work; create a letter and the letter to your insurance provider to request authorization to provide the crown. After paperwork is shuffled back and forth, the decision is finally made that the crown will be covered and that you must pay 20% of the total bill. The elapsed time from initial visit to approval could be months. With the use of an EDI Health Care Services Review (278), the approval process is greatly reduced while ensuring that both your dentist and your insurance company have appropriate documentation while ensuring that you only have to pay your part of the bill ...

EDI 276 & 277 Claims Status,  What's the Status ?

Imagine that you are a clinic administrator and you are in charge of claims processing for the entire clinic. You have thousands of outstanding claims and you need to know the status of each claim. . Let’s look at the options available from one of the most technologically aware insurance carriers/payers (Medicare) and let’s review what these options actually mean for a clinic administrator

TradeLink HIPAA EDI and b2b Gateway Overview

TradeLink EDI is a full featured EDI/XML business document broker system used to translate, exchange and audit the movement of business documents within an organizations trading community no matter what the format. Leveraging multiple security standards, TradeLink enables dynamic, secure interaction between partners over the Internet, with zero transaction cost. TradeLink is an exceptionally flexible solution. Developed in Java using J2EE and JDBC it can run on any Windows, or Linux system with most popular databases and application servers ...

Customer Case Studies

EDI 837 Solutions, Healthcare HIPAA Claims Management - Employers Direct Health

Employers Direct Health Inc. (EDH) a provider of group medical insurance integrated its custom claims processing application with the TradeLink EDI Management System and EDI services provided by SoftCare EC Inc. to automate the HIPAA health care benefits business process from the major Health Care Claims Clearinghouses ...

EDI 270 & 271 Solutions, Healthcare HIPAA Eligibility - Accumed Billing

AccuMed’s goal is to create a solution to send and integrate EDI HIPPA Health Care Eligibility Requests (270) and Responses (271) to/from major payers into their applications. ...

Technical Topics

WEDI SNIP Compliance Testing and Certification of HIPAA transactions

 The WEDI SNIP Transaction Set Testing Sub Workgroup has identified issues related to the testing and compliance certification of transactions as related to the HIPAA Transaction and Code Sets Final Rule. The purpose of this white paper is to:

Document the different types of testing available to the health care industry.
2. Identify the benefits of testing standards for compliance and certification of said data.
3. Document the savings that can be realized from testing and compliance certification.
4. Document our suggestions for compliance certification provided by the certification tools/services.