HIPAA

HIPAA allows your organization to implement the HIPAA 5010 and 5010A standards comprehensively and at scale. HIPAA streamlines the healthcare industry by providing the functionality to validate HIPAA transactions and generates the appropriate acknowledgments.

Supported HIPAA Transactions

HIPAA supports the following document types:

Action Description Document types
270 Health Care Eligibility Benefit Inquiry Determines whether a subscriber or dependent is eligible for certain claim benefits.
  • X12_5010_270_B1A1
271 Health Care Eligibility Benefit Response Requests an inquiry about the health care benefits and eligibility associated with a subscriber or dependent. The response document contains eligibility status, maximum benefits, in-plan/out-of-plan benefits, and co-payments.
  • X12_5010_271_A1
276 Health Care Claim Status Request Requests the status of a specified claim.
  • X12_5010_276_A1
277-A1 Health Care Information Status Notification The health care payer notifies the status of the adjudication process to the requestor or requests more information regarding a health care claim. If the request matches more than one claim in the payer’s system, the response may include multiple claims.
  • X12_5010_277_A1
277-B3 Health Care Claim Acknowledgment The health care payer acknowledges the claim of the requestor.
  • X12_5010_277_B3
278-A1 Health Care Service Review Information - Review Sends a health care services request for review to the health care provider, payers, delegated UMO entities, and other providers.
  • X12_5010_278_A1
278-A3 Health Care Service Review Information - Response Sends a health care services request for response to the health care provider, payers, delegated UMO entities, and other providers.
  • X12_5010_278_A3
820 Payroll Deducted and Other Group Premium Payment for Insurance Products Initiates a payment for insurance products with or without the remittance detail that a premium receiver needs.
  • X12_5010_820_A1
834 Benefit Enrollment and Maintenance Used to transfer enrollment information from the sponsor to a payer.
  • X12_5010_834_A1A1
835 Health Care Claim Payment/Advice Sends an Explanation of Benefits (EOB) remittance advice or make a payment and send an EOB remittance advice from a health care payer to a health care provider, either directly or through a Depository Financial Institution (DFI).
  • X12_5010_835_W1A1
837-Q1A1 Health Care Claim - Professional Insurance company submits healthcare claim billing information, encounter information, or both, from providers of health care services.
  • X12_5010_837_Q1A1
837-Q3A2 Health Care Claim - Institutional Insurance company submits healthcare claim billing information, encounter information, or both, from providers of health care services.
  • X12_5010_837_Q3A2
837-Q2A2 Health Care Claim - Dental Insurance company submits health care claim billing information, encounter information, or both, from providers of health care services.
  • X12_5010_837_Q2A2
Operation Description
convertHipaaMessageToDocument Converts a HIPAA message into a HIPAA document type.
convertDocumentToHipaaMessage Converts a HIPAA document type into a HIPAA message.

convertHipaaMessageToDocument

Converts a HIPAA message into a HIPAA document type. When creating an orchestration with convertHipaaMessageToDocument, you must select the appropriate document type. This is for the structure of a hipaaDocument to appear in the pipeline data when you map with another hipaaDocument during orchestration.

Input Parameters

  • hipaaMessage: Object. HIPAA message that is to convert into a document. Message only as stream or string is accepted.
  • encoding: String. Optional. The encoding of the message passed into hipaaMessage. Default character set is UTF-8.

Output Parameters

  • hipaaDocument: Document. The document represents the HIPAA message.
  • errorMessage: String. The error message describes the error when validating the message.
  • statusCode: String. Status code based on the success or failure of the operation.
  • statusMessage: String. Status message after executing the operation.

convertDocumentToHipaaMessage

Converts a HIPAA document type into a HIPAA message. When creating an orchestration with convertDocumentToHipaaMessage, you must select the appropriate document type. This is for the structure of a hipaaDocument to appear in the pipeline data when you map with another hipaaDocument during orchestration.

Input Parameters

  • hipaaDocument: Document. The document represents the HIPAA message.
  • delimiters: Document. Optional. Use delimiters to create the output HIPAA message. If you do not specify a delimiter, the convertDocumentToHipaaMessage service uses the default delimiters. Delimiters must always be a single character.
    • Segment: String. The segment terminator character to append to the end of each record in the output string.
    • field: String. The field separator to insert between each field for each segment in the output string.
    • subfield: String. The subfield separator to use for composite elements.
    • release: String. The field separator to insert between repeating fields of a document.

Output Parameters

  • hipaaMessage: String. The HIPAA message that is converted from the document.
  • errorMessage: String. The error message describes the error when validating the message.
  • statusCode: String. Status code based on the success or failure of the operation.
  • statusMessage: String. Status message after executing the operation.