ProductsMapForceEDI MappingHIPAA Compliance

Altova MapForce® 2008 allows you to visually map to and from all of the different ANSI X12 transaction sets that are required to comply with HIPAA regulations. Strong support for X12 means that members of the healthcare community can seamlessly and efficiently transform incoming and outgoing patient health claims, eligibility and status documents, claim payment and workers’ compensation forms.

Enacted by the United States Congress in 1996, the Health Insurance Portability and Accountability Act (HIPAA), is a set of rules and regulations that, among other things, establishes standards for the transmission of electronic healthcare transmissions. HIPAA employs a specific subset of the X12 library of standards to promote a uniform file format for electronic communication across the national healthcare industry.

The following key X12 transaction types are included in the HIPAA mandate*:

• 270        Eligibility, Coverage, or Benefit Inquiry
• 271        Eligibility, Coverage, or Benefit Information
• 276        Health Care Claim Status Request
• 277        Health Care Information Status Notification
• 278        Health Care Services Review Information
• 820        Payment Order / Remittance Advice
• 834        Benefit Enrollment & Admittance
• 835        Health Care Claim Payment/Advice
• 837        Health Care Claim (separate IGs for Dental, Institutional, or Professional)

*These standards and others are overseen by ANSI X12 subcommittee N, which covers the insurance industry, and are often referred to as X12N standards.

HIPAA X12 Mapping

Due to the complexity of both the raw data being transmitted and the X12N file formats, as well as rigorous Implementation Guides, mapping HIPAA compliance data to and from its intermediate EDI format(s) is an arduous and often error prone task.

MapForce’s visual interface with support for mapping X12 to and from XML, databases, flat files, Excel 2007, Web services, and other EDI formats enables you to maintain control over your HIPAA implementation throughout. Advanced features like data processing functions, code generation, and even a visual function builder, help you to deploy an accurate and fully functional mapping or integrated mapping application that can be iterated over again and again.

The screenshot below shows a real-world example of a complex mapping from a state system’s ANSI X12 eligibility file to integrate membership file data for public sector healthcare.

	Click to enlarge

MapForce supports all X12 transaction sets, including version 5010, which has been recently proposed for adoption by the Department of Health and Human Services, and is a key component for implementing ICD-10-CM for diagnosis codes as well as ICD-10-PCS for inpatient hospital procedures.

Harness the power of MapForce® for all of your HIPAA and X12 mapping needs. Download a free 30-day trial of MapForce.