ProductsMapForceEDI MappingHIPAA X12

Altova MapForce® 2012 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.

MapForce provides built-in support for the most current release of HIPAA. Configuration files for messages covered by the HIPAA-X12 standard can be downloaded at the library installer page.

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

	270-B1		Health Care Eligibility Benefit Inquiry
	271-B1		Health Care Eligibility Benefit Response
	276-A1		Health Care Claim Status Request
	277-A1		Health Care Information Status Notification
	277-B3		Health Care Claim Acknowledgement
	278-A1		Health Care Services Review - Request for Review
	278-A3		Health Care Services Review - Response
	820-A1		Payroll Deducted and Other Group Premium Payment for Insurance Products
	834-A1		Benefit Enrollment and Maintenance
	835-W1		Health Care Claim Payment/Advice
	837-Q1		Health Care Claim - Professional
	837-Q2		Health Care Claim - Dental
	837-Q3		Health Care Claim - Institutional
	999-A1		Implementation Acknowledgement for Health Care Insurance

*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 HIPAA-X12 transaction sets in version 5010, which has been mandated by the Department of Health and Human Services for adoption by January 1, 2012, 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.