EDI & Healthcare Claims Processing
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Secure, HIPAA-compliant integration and interoperability
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) dramatically changed the business environment of the healthcare industry. One of HIPAAs key outcomes was that it prompted a wave of new federal regulations, not least of which required healthcare organizations to use a standardized format when submitting electronic transactions (including healthcare claims, payment and remittance, purchase orders, and invoicing).
These changes forced EDI (electronic data interchange) to quickly become the de facto standard for the healthcare industry. With electronic information exchange a critical component of the industry's day-to-day business, EDI's success was no surprise. EDI drives business process efficiency and reduces costs by eliminating the high error ratios and expenses normally associated with manual claims processing.
Fully-functioning EDI on the World's Most Complete Document Exchange Platform
CyberFusion Integration Suite (CFI)™, from Proginet, provides full EDI functionality through its integrated Commerce Server, Platform Server, and Internet Server modules: Commerce Server provides the interface between the healthcare organizations and their external trading partners sending/receiving claims in EDI format; Platform Server interfaces between the received/sent EDI documents and the organization's internal systems; Internet Server provides strong B2B communications by providing the secure connection to the clearinghouses, healthcare providers, and other external business partners.
Key Features:
- » Support for EDI over the Internet using our AS2 compliant EDI communications module. Other supported communication protocols include HTTP, HTTPS, FTP, SFTP, FTPS and SSH.
- » Extended mapping functionality to quickly and efficiently define and manage transformations from/to EDI, XML, database, variable or fixed length files to a company's business systems.
- » Support of X12, UNEDIFACT and xCBL standards.
- » Simplified trading partner setup.
- » Browser-based front end allows for centralized communications and document management.
- » Built in business process management (BPM) features to allow full integration of a company's business processes to move business documents of any format to/from an organization's back-end systems.
- » Event-driven alert management to allow the end user to receive real-time e-mail notifications of document processing problems.
- » Multiple consistent levels of audit (operations summary, business process, task, file, document and communications) allow an end user to quickly identify and efficiently track document issues. This includes transaction tracking, reporting and data retention with actionable audit trails and persistent queuing.
Used by leading organizations worldwide, including many of the Fortune 500, CFI is the platform of choice for organizations engaged in EDI-based healthcare claims processing.
CyberFusion Integration Suite (CFI)™Learn more about CFI and how to maximize the success of your EDI healthcare initiatives.
