DP Solutions - HIPAA Transactions & Code Sets

HIPAA-Compliant Healthcare EDI Solutions

Visit our Dedicated Healthcare Website for More Information on Healthcare EDI Products & Services.

Need help building 837 transaction files? Need assistance processing 835 files? Need a custom 270/271 application that will integrate into your existing system? We specialize in developing custom transaction translator and claims processing solutions that fit your business needs exactly. DPS offers anywhere from complete claims processing and patient account reconciliation systems to highly customized single function EDI translation components.

Healthcare EDI Services and Solutions
Skill Sets
HIPAA Transactions Supported

Compliance Levels Implemented
Database Design Deficiencies Found and Remedied
Who Benefits From Our Solution?

Healthcare EDI Services and Solutions

Extract claim information directly from your existing database tables using COM+ and .NET component technologies. Assemble, validate, encrypt and transport batches of 837P, 837I or 837D files directly to your payers and trading partners.
Parse incoming payment (835) transactions and insert the data into your database tables for claim reconciliation.
Develop Web or Windows front end applications for submitting HIPAA-compliant electronic claims to payers.
Develop highly customized reports of all claim transaction and claim payment activities.
Translate existing non-standard claim files such as NSF 2.0, NSF 3.0 or Print Image into standard HIPAA-compliant X12N files.
DPS will perform a complete and thorough Gap Analysis of your current data and database structures.

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Skill Sets

Training from Washington Publishing Company, the exclusive authors of the HIPAA X12N implementation guides.
Our development languages consist of VB, VBA, VBScript, XSL, XSLT, T-SQL, VB.NET, and C#.
Expert EDI, SQL and XML programmers on staff.
Healthcare EDI specialists.
Data and relational database architects with over 20 years of experience.
We understand the electronic medical claim cycle and its associated processes.
Our staff has a thorough understanding of the data elements, segments and loops that make up the hierarchical structure of an EDI document.
Certified network engineers, network architects, and security specialists.
Medical coding experience that includes: ICD-9-CM, CPT 4, HCPCS Level II, provider taxonomy codes, etc.

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HIPAA Transactions Supported

837P: Health Care Claim: Professional
837I: Health Care Claim: Institutional
837D: Health Care Claim: Dental
835: Health Care Claim Payment/Advice
270/271: Health Care Eligibility, Coverage or Benefit Inquiry and Information Response
277/275: Health Care Claim Request for Additional Information and Response
276/277: Health Care Claim Status Request and Response
834: Benefit Enrollment and Maintenance
820: Payroll Deducted and Other Group Premium Payment for Insurance Products
278: Health Care Services Review -- Request for Review and Response

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Compliance Levels Implemented

Level 1: Integrity Testing
Level 2: Requirement Testing
Level 3: Balancing
Level 4: Situational Testing
Level 5: Code Set Testing
Level 6: Line of Business Testing
Level 7: Trading Partner Testing

Note: By far, what we have found to be the single most problematic find while performing Gap Analysis and implementing translation solutions in the healthcare industry are improperly designed relational databases. We cannot over stress the importance of a properly designed relational database. The integrity of your data and its accurate retrieval depend on it!

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Database Design Deficiencies Found and Remedied

Over normalized databases resulting in hundreds of unnecessary tables and an overly complex database structure.
Fields that do not belong in a particular table or duplicate non-key fields.
Existence of multipart, multivalued, or calculated fields in the database.
Improper table relationships
Duplicate records resulting in weak data integrity and inaccurate data retrieval.
Orphaned records resulting in weak data integrity and inaccurate data retrieval.
Weak key relationships.
Hard to maintain code workarounds due to an improperly designed database.
Overly complex SQL statements due to an improperly designed database.
Difficulty inserting, updating or deleting data due to an improperly designed database.

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Who Benefits From Our Solution?

You are currently moving from paper-based claims submission to electronic transactions.
Your employees are keying the same claim information into two or more systems. You need to integrate existing systems in order to reduce the waste and errors associated with re-keying data.
Your company has suffered a failed implementation due to lack of proper analysis on the part of a consultant.
Your business needs have outgrown your current claims processing software.
You have decided to go direct to the payer instead of paying those high clearinghouse transaction fees.
You are looking for IT consultants that know the difference between a J-code and an E-Code.
Your current IT consultant looks at you with confusion when asked what claim information is found in loop 2400 of an 837P transaction.
Your programmers are puzzled by the hundreds of connecting lines and functoid icons between two specifications in the mapper tool of a commercial translator.
Creating a single electronic 837 claim file poses no problem but assembling batches of claims are problematic for your programmers due to non-intuitive looping mechanisms in the mapping software (Note: HL segment parent and child id elements play an important role in proper 837 batch structure).

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