HIPAA
HIPAA allows your organization to implement the HIPAA 5010 and 5010A standards comprehensively and at scale. HIPAA streamlines the healthcare industry by validating HIPAA transactions and generates the appropriate acknowledgments.
Supported HIPAA transactions
Document types that HIPAA supports
| HIPAA compliant standard | Description | Document types |
|---|---|---|
| 270 Health care eligibility benefit inquiry | 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 or out-of-plan benefits and copayments. | 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 requester or requests more information regarding a health care claim. If the request matches more than 1 claim in the payer’s system, the response might include multiple claims. | X12_5010_277_A1 |
| 277-B3 Health care claim acknowledgement | The health care payer acknowledges the claim of the requester. | 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 makes a payment and sends an EOB remittance advice from a health care payer to a health care provider. EOB is sent 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 |
The predefined operations.
| 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. Selecting an appropriate document type help ensure 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 to convert into a document. Message as stream or string is accepted.
- encoding
- String. Optional. The encoding of the message passed into hipaaMessage. The 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 running 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. Selecting an appropriate document type help ensure 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 be
a single character.
- Segment
- String. The segment terminator character that is appended to the end of each record in the output string.
- field
- String. The field separator that is inserted 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 that is inserted between repeating fields of a document.
- Output parameters
-
- hipaaMessage
- String. The HIPAA message, which 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 running the operation.