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
Solution Framework
  • 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
Solution Delivered
  • Successfully Developed and Implemented Compliance solution for HIPAA 837,835,270 transactions
  • Leveraged extensive analysis of incremental changes in 5010 and configured the Maps using Impact Assessment Study to understand the existing Code base
Key Technologies Used
  • BizTalk 2009
  • Mainframe
  • Visual Studio 2008
  • SQL server 2008
  • Design Tools
  • OTIS
  • Tibco
  • HP Quality Center