Key Features
Operational Integrity for Your Transactions
To ensure ongoing operational data integrity, you need go beyond pre-production and 3rd party testing.
Healthcare organizations need to include a validation engine as part of their in-stream production data flow.
While pre-production and 3rd party testing are a good first step in the process to ensure that you and your
trading partner can exchange files, they do not guarantee that all files coming into your production system will
meet your business requirements.
The benefit of an in-line validation engine is that it will check every data file. By catching errors as early in the
process as possibly, your organization will save time and money associated with dealing with poor or corrupt data ending
up in your back-end system. Additionally, your trading partners will be notified immediately as to the cause and location
of the errors in their original data file, so that they can quickly fix the problem and resubmit the data.
Edifecs XEngine can also validate data before it leaves your organization, so you can verify that the data will meet
your trading partners’ business requirements. Errors can be separated from valid transactions before leaving the
organization, ensuring that your trading partner will not reject an entire batch of data because of few errors.
HIPAA Transaction Validation for Compliance
For entities covered under the federal HIPAA regulations, compliance is mandated under federal law. For HIPAA,
Edifecs XEngine works in conjunction with you existing translation package. Edifecs XEngine provides full compliance
checking against all HIPAA implementation guideline rules, as well as your trading partner-specific requirements:
- WEDI SNIP Types 1-6
- Your own or your trading partner’s Companion Guide edits (WEDI-SNIP type 7)
- 60+ External code sets, updated monthly
- Correct Coding Initiative (CCI) edits
For incoming data, Edifecs XEngine is placed prior to your translation system, so only HIPAA compliant data is passed
to your down-stream systems. For outgoing data, Edifecs XEngine is placed after the translation software so any errors
can be caught before sending the data to your trading partner, providing you the opportunity to fix errors prior to
data leaving your organization.
Messaging Screening, Filtering and Splitting
In addition to data integrity and transaction compliance checking, Edifecs XEngine can also screen and filter out the bad
data from the good data. The filtering can be done at various levels based on your business needs — by transaction or at
logical business unit level such as Payer, Subscriber, or Claim. By processing as much good data as possible, resubmission
costs will be reduced significantly because only the bad data needs to be re-submitted. This capability saves you time
and money whether you are a payer, provider, clearinghouse or vendor.
Application Data Routing
In addition to filtering good data from bad, Edifecs XEngine can also be used as an application data router.
Because it is part of the front-end process doing validation, Edifecs XEngine can look at the data content and use
information such as file type, transaction type, trading partner, purpose, or even member or provider ID, to route the
data to appropriate downstream applications.
This functionality has many uses in any healthcare enterprise:
- It can be used to route data to different back-end systems such as different claim adjudication systems for
different receivers or payer IDs.
- It can be used to distinguish between real-time and batch transactions and route the data to the
appropriate servers to provide proper load balancing and meet required response times.
- It can be used to prioritize transaction processing — eligibility transactions may be more critical than claim transactions, etc.
Transaction and Data Format Conversion
In addition to compliance checking and message filtering, Edifecs XEngine also provides the ability to convert data from its native format such as EDI, NSF, HL7, etc. to an equivalent XML format.
Some of the key benefits of being able to get the data in XML format include:
- No need to write code or develop applications to understand the various native formats.
Edifecs XEngine provides the pre-built parsers for these formats out of the box.
- No need to keep up to date with ongoing standards changes such as new releases of code sets, HIPAA v5010, Claims Attachments, NPI.
- Leverage free, open source third party tools such as Xerces and other XML parsers to read the entire document,
or use XPath to extract just some key values from the document.
- Leverage additional new technologies that have been developed for XML and now apply them to other file formats.
For example, use style sheets (XSLTs) to present the converted native data to your users in a friendly and easy to use manner.
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