Health Policy

Download BizTalk 2013 EDI for Health Care: HIPAA-Compliant 834 by Mark Beckner PDF

By Mark Beckner

BizTalk 2013 EDI for Healthcare – EDI 834Enrollment Solutions gets rid of the complexity anddemonstrates the best way to construct either inbound and outbound EDI 834 techniques inBizTalk server that keep on with the mandatory styles for integrations with theseexchanges. Archiving, mapping,reconstituting EDI 837 information, exception dealing with and complicated logging andreporting (without the necessity for BAM!) are all coated in adequate aspect to allowyou to enforce your personal totally sensible resolution.

The cheap CareAct and the necessities to combine with nation Exchanges have securedBizTalk’s function with integrations in the healthcare undefined. EDI 834 records are the guts to allintegrations, facing enrollment and the upkeep of enrollments. so as to effectively combine with theexchanges, businesses are required to enforce a few architectural componentsthat could be daunting and complicated to paintings via. top quality assets for IT expert to address those demanding situations are sorely wanted, and this source has been designed to supply concise solutions.

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Additional info for BizTalk 2013 EDI for Health Care: HIPAA-Compliant 834 (Enrollment) and 837 (Claims) Solutions

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It will introduce how to pull data from a source SQL Server database, map that data to an outbound 837P document, and batch the results into one file with multiple claims per ST/SE. There will be important information presented about how best to interact with SQL from BizTalk, how to structure the source data you'll be mapping from, and how to batch the data using configurations available in the BizTalk Party Agreement. The architectural overview of this solution is shown in Figure 3-1. SQL Stored Procedure File Receive Port XML SQL Receive Port BizTalk Batching Engine File Send Port SFTP Send Port Map Individual 837 Files Batched 837 Files Figure 3-1.

The approach that allows for the most extensive flexibility around retrieving data, performing some level of data validation or cleansing, and formatting it in a “BizTalk friendly” way is through the use of a stored procedure. If you have not used XML within SQL Server before, you are going to want to learn, as it is essential to building solid, easy to maintain solutions within BizTalk. The stored procedure that you will be using for this current solution is structured in the following way: • Retrieve data directly from databases and structure it in a mapping ready format.

58 Mapping Data Chapter 4 Figure 4-10. A Scripting Functoid for Mapping Transaction Type Listing 4-8. Mapping the Transaction Type public string GetTransactionType(string BGN08, string N103) { string result = null; if (BGN08 == "2") { if (N103=="24") result = "SHOP Enrollment"; else result = "Individual Enrollment"; } if (BGN08 == "4") { if (N103=="24") result = "SHOP Reconciliation"; else result = "Individual Reconciliation"; } return result; } 59 Chapter 4 Mapping Data Conclusion This chapter gives an overview of how to be successful with your mapping solutions.

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