HIPAA Claim Master, developed by HIPAAsuite, is a comprehensive software solution designed to master every aspect of the complex HIPAA X12 837 Electronic Claims transaction set. It is an essential tool for healthcare providers, billing services, and payers looking to streamline their claims management and eliminate reliance on third-party clearinghouses.
Key Features and Capabilities:
- 837 EDI Management: Create, read, parse, and check for HIPAA compliance on 837 EDI files (Professional, Institutional, Dental, Ambulance, etc.).
- Human-Readable Viewing: Allows users to view the cryptic EDI files in familiar, standard claim forms such as the CMS 1500, UB-04, and ADA 2012.
- Database Integration (DB Connect): Connects to and exports/imports claim data to a wide variety of ODBC-compliant databases, including Microsoft SQL Server, Oracle, and MySQL, allowing for seamless integration with existing in-house systems.
- Claim Entry & Editing: Features a user-friendly interface for manual claim entry, enabling the conversion of paper claims into the 837 electronic format. Users can also easily edit any claim data stored in the database.
- Claims Status & Acknowledgement: Supports the creation of 277CA Claim Acknowledgments and is part of a suite that handles the full claim lifecycle.
- EDI Exchange: Includes an optional EDI Exchange component for direct file transport (FTP/SFTP) with trading partners, eliminating middleman costs.
Target Users and Use Cases:
The software is suitable for all healthcare entities, from small medical practices to large healthcare facilities and enterprises. Its primary use cases include converting non-electronic claims to 837 EDI, auditing and editing complex EDI files, and establishing a secure, compliant, and self-hosted system for direct claims exchange with payers.
