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

By Mark Beckner

BizTalk 2013 EDI for Healthcare – EDI 834Enrollment Solutions gets rid of the complexity anddemonstrates the right way to construct either inbound and outbound EDI 834 techniques inBizTalk server that persist 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 sufficient aspect to allowyou to enforce your personal absolutely practical answer.

The cheap CareAct and the necessities to combine with nation Exchanges have securedBizTalk’s function with integrations in the healthcare industry.  EDI 834 files are the guts to allintegrations, facing enrollment and the upkeep of enrollments.  so one can effectively combine with theexchanges, businesses are required to enforce a couple of architectural componentsthat should be daunting and intricate to paintings via. top of the range assets for IT specialist to deal with those demanding situations are sorely wanted, and this source has been designed to supply concise solutions.

What you’ll learn

  • research easy methods to improve whole finish to finish EDI 834 strategies, either inbound and outbound
  • Create a resolution that demonstrates the way to combine with kingdom Exchanges
  • Explore strategies for customized pipeline parts, archiving styles, lookups
  • Detailed details for complicated 834 EDI mapping

Who this publication is for

BizTalk directors and builders, in addition to administration body of workers attached with those positions.

Table of Contents

1.  Architectural Patterns

2.  Solution: Receiving 837P Data

3.  Solution: Sending 837P Data

4.  Mapping Data

5.  Adapters, AS2 and Acks

6.  Solution: Receiving 834 Data

7.  Pipelines for 834 Processing

8.  Custom company Rules

9.  Advanced 834 Mapping

10.  Solution: Sending 834 Data

11.  Solution: Sending 834 info, Simplified

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Additional info for BizTalk 2013 EDI for Health Care: HIPAA-Compliant 834

Example text

The patterns you will look at include details on: Receiving inbound 837P files Receiving data via SFTP, FTP, and AS2 Decrypting inbound data Mapping to other 837P versions, proprietary flat file formats, and SQL Server databases Returning acknowledgements Working with orchestrations Sending outbound 837P files Mapping from internal flat file formats Creating source data from SQL Server Encrypting data Sending batched and unbatched data Working with orchestrations The Benefit Enrollment and Maintenance 834 Format The 834 format is not as complex to map (in most cases) as the 837, but it does have a number of architectural requirements that are often required.

This chapter will look at outbound 837P data. 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.

Details for mapping the 837P are given in Chapter 4, “Mapping Data”. Š NoteŠŠ If you are delivering multiple document types - such as 837 Professional, Institutional, and Dental - out to multiple trading partners, you might want to explore the idea of mapping the source data from SQL Server to a canonical structure, and the canonical structure to the target 837P. In some cases, you can reduce overall long-term development through the use of a canonical schema, though short term it will increase development efforts and testing requirements.

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