The customer is a Health Insurance Company
Scope of Work
- Map in-coming Claims as per HIPAA regulations for.
- HIPAA 837,835,270 transactions
- Validate transactions through Tibco gateway
- Receive EDI data and map to BizTalk and then converted onto the claims processing systems.
- Translate the data from the 837 into a processing format for the adjudication systems
- TIBCO gateway validates transaction and will send an XML file to BizTalk that will de-envelop the message for further verification and validations.
- A web service used to apply the edits to institutional, professional and dental claims (837I, 837P & 837D)
- 835 is generated through the CPS by recreating the validations