Electronic Data Interchange:
HSP EDI/HIPAA Gateway

HSP’s comprehensive HIPAA Gateway simplifies the day-to-day management of Electronic Data Interchange (EDI) transactions and eliminates the need for clearinghouses and other third-party gateways; it can also work in conjunction with such entities to meet your business requirements. The system captures all required elements from all of the standard HIPAA 5010 transactions. Through HSP’s HIPAA Gateway, you are able to define what type of information will be loaded into the system.

HSP continually keeps the system in step with regulatory requirements such as HIPAA 5010, ICD-10 role-based security, etc. Security features comply with applicable federal (HIPAA) mandates for data integrity, confidentiality, auditing and availability.

Meet 5010 HIPAA requirements:

HIPAA Gateway captures all required elements from all of the standard HIPAA 5010 transactions. The system has the ability to process and manage the following standard 5010 HIPAA transactions:

  • Claims or equivalent encounters (837) In/Out
  • Coordination of Bbnefits (837) In/Out
  • Eligibility (270/271)
  • Health care claims status (276/277)
  • Enrollment / disenrollment full roster In/Out (834)
  • Enrollment/disenrollment maintenance (834)
  • Healthcare payment and remittance In/Out (835)
  • Health plan premium (820)
  • Referral certification and authorizations (278)
  • Acknowledgement (997,999)
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    Custom data extracts including:

  • Claim and encounter data
  • Eligibility
  • Authorizations
  • Provider data
  • Workers’ Compensation

HSP EDI/HIPAA Gateway allows you to:

  • Automate and streamline operations while reducing costs
  • Fully integrate your system without the need for third-party solutions
  • Create user-defined configuration for processing intermediary and partner transactions and have complete trading partner management
  • Automate edit determination and error correction workflows
  • Route split transactions to the appropriate receiver based on your business requirements
  • Complete in-depth file scrubbing for enrollment reconciliation
  • Ensure the validity of the data before it is loaded into your production environment
  • Enjoy end-to-end visibility and insight into the entire transaction cycle
  • Create and maintain inbound and outbound EDI maps
  • Utilize standard and custom reporting, load wizards and an intuitive graphical user interface
  • Have 4010, 5010 and ICD-10 compatibility