You are on page 1of 12

A c hi ev e tra n sa c ti on in tero p e ra b ility faster

Edifecs XEngine
Transaction Validation Solution

Dramatically improve your healthcare transaction automation

THE DNA OF B 2B

Edifecs XEngine
INTRODUCTION

In this time of increasing financial, operational and regula- Key Transaction-Related Questions
tory pressures on health plans, payers and providers, ex- for Healthcare Organizations
ecutives are discovering that electronic transactions pres-
What tools can I use to ensure that the data is compli-
ent as many challenges as they do opportunities. HIPAA
ant not just with HIPAA, but with my business specific
legislation mandated the use of standard transactions
requirements, and those of my trading partners?
and code sets between trading partners, in an attempt to
ease the burden of telephonic and paper communication Do I need different software systems for different stan-
between payers, providers, employers and other stake- dards such as HL7, NCPDP, and legacy file formats?
holders. However, as almost everyone has discovered How will I manage, enforce, or relax edits and errors,
many backend processes and systems have very specific based upon the different needs of my trading partners?
data content and format requirements, allowable under
HIPAA, in order to achieve the highest possible levels of Different types of submitters need to send different
automation. Contrary to the intent of the law, in many types of data in the transactions. How will I manage to
cases, automation rates have gone down, not upcreating ensure that I receive this data when I need it?
unintended costs and negative impacts for payers, provid- How can I split and route transactions once they hit my
ers and consumers. firewall to the right adjudication system, to a carve-
out vendor, or even to separate good transactions from
HIPAA transactions are not the only standards that
bad transactions?
healthcare organizations must support to be effective
and efficient. Other standards such as HL7, NCPDP, NSF, How will I generate the appropriate acknowledgments
UB92 and even proprietary file formats must be sup- and error messages when bad transactions are re-
ported, given the wide variety of trading partner require- ceived?
ments. All these requirements have created a number How will I keep up with the standards and code sets as
of questions that organization leadership should address they change and evolve, and with new standards as they
to be responsive to their markets. The answers to these are implemented?
questions can determine whether an organization can
create and maintain a strategic advantage leveraging elec- How can I serve up this EDI data for new value-added
tronic trading relationships. applications in my organization without a huge amount
of translator maintenance and cost?

Edifecs XEngine in the Edifecs Healthcare Suite

page 2 of 12 Edifecs XEngine


Edifecs XEngine EDI Adaptor for Key Benefits of XEngine
Healthcare:
Ensures operational integrity with clean, validated trans-
action data passed to and from your back-end systems,
Validate,Split,Route and Transform Your validated against existing standards such as WEDI-SNIP
Transactions for Maximum Automation
Types 1-6, or against your trading partner-specific
Edifecs, the leading provider of B2B solutions for transac- requirements
tion-based interoperability, addresses all of these ques-
tions with Edifecs XEngine, our market-leading produc- Provides rich reporting to you and your trading part-
tion validation technology. An integral part of the Edifecs ners for rapid error resolution
Healthcare Suite, Edifecs XEngine ensures interoperability Delivers a complete library of healthcare standards-
with trading partners by validating healthcare and Global HIPAA, HL7, NCPDP, support for proprietary positional
Markets transactions for syntax, semantics and trading and delimited flat file formats and XML-based format--
partner-specific business rules. With real-time edits and for true standards independence
filters on the data entering or leaving your enterprise,
Automates the generation of the acknowledgement
you are assured that your back-end applications and data
transactions- TA1, 997 and 824
warehouses, as well as those of your trading partners,
contain accurate and valid transaction data, and achieve Automatic conversion to XML format for all transac-
maximum transaction automation. tion types- reduces costs associated with maintaining
By moving your specific requirements in front of those complex mapping
backend systems, you can proactively catch and manage Provides a completely integrated design-time and run-
exceptions that will cause adjudication rates to fall. With time environment with Edifecs SpecBuilder design-time
Edifecs XEngine you can: tools
Validate production data for compliance with HIPAA, Scalable to even the most high-volume environments,
HL7, NCPDP or proprietary formats and rules, includ- with the most robust cross-platform support in the
ing WEDI SNIP Types 1-6 for HIPAA transactions out of market
the box
Rapid and flexible implementation options- install and
Validate that data against your Companion Guide spe- implement in a matter of days, through either stand-
cific edits, by trading partner or service type, before it is alone server or through the use of robust Java APIs
passed through to hit your backend systems
Relax edits for specific trading partners, to create warn-
ings, informational responses, or simply ignore the edit
Split and re-batch transactions in real-time: good from
bad, or based on content
Receive automated error reports in human readable
and XML formats to share internally or with trading
partners
Keep abreast of the latest transaction versions, as well
as over 60 code set updates through monthly execut-
able updates, and stay up-to-date with ICD-9, CPT-4,
NDC and SNFR-HIPPS codes
Automatically create acknowledgement messages such
as 997, TA1, 997 and 824 transactions
Automatically transform EDI data into XML, for
consumption by other systems or processes in your
organization

Edifecs XEngine Data Splitting and Routing

Edifecs XEngine page 3 of 12


WHY YOUR ORGANIZATION NEEDS EDIFECS XENGINE

To ensure ongoing operational data integrity, you need go Edifecs XEngine Human Readable
beyond pre-production and 3rd party testing. Healthcare Error Report Example
organizations need to include a validation engine as part
Once your data is validated, Edifecs XEngine generates an
of their in-stream production data flow. While pre-pro-
EDI acknowledgment message to send back to your trad-
duction and 3rd party testing are a good first step in the
ing partner and also produces a rich machine and human
process to ensure that you and your trading partner can
readable report detailing the quantity, type, and severity
exchange files, they do not guarantee that all files coming
of errors found.
into your production system will meet your business
requirements.
The benefit of an in-line validation engine is that it will
check every data file. By catching errors as early in the
process as possibly, your organization will save time and
money associated with dealing with poor or corrupt data
ending up in your back-end system. Additionally, your
trading partners will be notified immediately as to the
cause and location of the errors in their original data file,
so that they can quickly fix the problem and resubmit the
data.
Edifecs XEngine can also validate data before it leaves
your organization, so you can verify that the data will
meet your trading partners business requirements.
Errors can be separated from valid transactions before
leaving the organization, ensuring that your trading part-
ner will not reject an entire batch of data because of few
errors. Edifecs XEngine Human Readable Error Report Example

HIPAA Transaction Validation for


Compliance
For entities covered under the federal HIPAA regulations,
compliance is mandated under federal law. For HIPAA,
Edifecs XEngine works in conjunction with you existing
translation package. Edifecs XEngine provides full compli-
ance checking against all HIPAA implementation guideline
rules, as well as your trading partner-specific require-
ments:
WEDI SNIP Types 1-6
Your own or your trading partners Companion Guide Edifecs XEngine Machine Readable Error Report Example:
edits (WEDI-SNIP type 7) 824 Acknowledgement

60+ External code sets, updated monthly


Correct Coding Initiative (CCI) edits
For incoming data, Edifecs XEngine is placed prior to
your translation system, so only HIPAA compliant data is
passed to your down-stream systems. For outgoing data,
Edifecs XEngine is placed after the translation software
so any errors can be caught before sending the data to
your trading partner, providing you the opportunity to fix
errors prior to data leaving your organization.

page 4 of 12 Edifecs XEngine


Messaging Screening, Filtering and Application Data Routing
Splitting
In addition to filtering good data from bad, Edifecs
In addition to data integrity and transaction compliance XEngine can also be used as an application data router.
checking, Edifecs XEngine can also screen and filter out Because it is part of the front-end process doing valida-
the bad data from the good data. The filtering can be tion, Edifecs XEngine can look at the data content and
done at various levels based on your business needs- by use information such as file type, transaction type, trading
transaction or at logical business unit level such as Payer, partner, purpose, or even member or provider ID, to
Subscriber, or Claim. By processing as much good data as route the data to appropriate downstream applications.
possible, re-submission costs will be reduced significantly
because only the bad data needs to be re-submitted. This This functionality has many uses in any healthcare
capability saves you time and money whether you are a enterprise:
payer, provider, clearinghouse or vendor. It can be used to route data to different back-end
systems such as different claim adjudication systems for
different receivers or payer IDs.
It can be used to distinguish between real-time and
batch transactions and route the data to the appropri-
ate servers to provide proper load balancing and meet
required response times.
It can be used to prioritize transaction processing
eligibility transactions may be more critical than claim
transactions, etc.

Edifecs XEngine Splitting Scenario Examples

Edifecs XEngine page 5 of 12


Transaction and Data Format Supported Healthcare Standards
Conversion
Edifecs XEngine supports more healthcare standards
In addition to compliance checking and message filtering, than any other solution on the market. In addition to the
Edifecs XEngine also provides the ability to convert data most robust standards support, Edifecs XEngine supports
from its native format such as EDI, NSF, HL7, etc. To an the need that most healthcare organizations have for
equivalent XML format. proprietary formats that may be required due to internal
systems, or that a trading partner may need to achieve
Some of the key benefits of being able to get the data in
interoperability with your organization. Supported stan-
XML format include:
dards include:
No need to write code or develop applications to
HIPAA X12 all mandated transactions and over 60
understand the various native formats. Edifecs XEngine
code sets, and support for 275 Attachment transactions
provides the pre-built parsers for these formats out of
and 277U as these standards evolve
the box.
Standard X12
No need to keep up to date with ongoing standards
changes such as new releases of code sets, HIPAA NCPDP Batch and Telecom
v5010, Claims Attachments, NPI. HL7- all 2.x versions and support for XML standards as
Leverage free, open source third party tools such as they evolve
Xerces and other XML parsers to read the entire NSF
document, or use XPath to extract just some key values
from the document. UB-92

Leverage additional new technologies that have been Delimited Flat File
developed for XML and now apply them to other file Positional Flat File
formats. For example, use style sheets (XSLTs) to pres-
And more!
ent the converted native data to your users in a friendly
and easy to use manner.

Edifecs XEngine XML Conversion Example

page 6 of 12 Edifecs XEngine


Easy Installation and Flexible Implementation

Edifecs fully understands that Edifecs XEngine will be op- Trading Partner Integration
erating within your larger enterprise integration eco-sys- Just as we provide many options for integrating Edifecs
tem. Therefore, we provide you with an array of choices XEngine in your environment, we also provide various
as to how you would like to use Edifecs XEngine in your options for managing trading partner configuration. If you
environment.You are free to choose any of the following already have an existing trading partner management sys-
integration options, and to mix and match different imple- tem, you can continue to use it through Edifecs XEngines
mentations for production vs. Test environments. open architecture. By extending your infrastructure to
include guidelines needed for validation, you can leverage
Java API your existing trading partner database system and keep
Edifecs XEngine exposes a full-featured, Java Interface all trading partner information in a central repository.
(using JNI) that you can wrap your own solution around. Integration with your existing trading partner database
This gives you greater flexibility in your choice of operat- can be done either using COM or Java interfaces.
ing system environments, and lets you leverage the full Alternatively, Edifecs XEngine also comes with a default
range of services that the J2EE environment offers to trading partner configuration file which can be used for
integrate, deploy, and manage Edifecs XEngine with your simple configurations. Edifecs XEngines built-in trading
enterprise applications and with Web services-enabled partner module makes it possible for you to validate data
multi-tier enterprise applications. based on just the message type, or you can direct the
validation to be performed based on the specific sender/
COM API receiver IDs and the type of data that was sent.
Edifecs XEngines component object module (COM)
interface makes it possible for you to integrate Edifecs
XEngine in Windows environments.You can leverage
COMs integrated services and features, and use Edifecs
XEngine components with any of Microsofts program-
ming languages. Edifecs XEngines COM interface also
makes available to you the wide variety of .NET tools,
services, clients, and servers, which empower you to build
powerful software and systems through Web services.

Command-line Executable
For some applications, the old standby of a command-
line execution still works the best. Business analysts and
non-programmers can use Edifecs XEngines standalone
command-line executable to validate and convert data
files quickly and easily without the need to write any
code.

Server Edition
Edifecs XEngine Server is ideal for those customers want-
ing to use the full-featured Edifecs XEngine without writ-
ing any code, yet still run it as an autonomous application.
Edifecs XEngine Server on Windows can be installed as
a Windows service and on non-Windows platform as a
daemon process. Edifec XEngine Server comes fully load-
ed with a thread pool library to manage multiple threads,
and a complete set of connectors to connect with IBM
Websphere MQ, SeeBeyond JMS, TIBCO EMS, Sun JMS,
FTP and simple file folders. Additionally, it allows you to
specify multiple pipelines so that you can have separate
processes for real-time vs. batch.

Edifecs XEngine page 7 of 12


RELATED PRODUCTS IN THE EDIFECS HEALTHCARE SUITE

Edifecs XEngine is tightly integrated with other Edifecs products in the Edifecs Healthcare Suite, a set of powerful
applications, tools and technologies that reduce friction in the administrative, clinical, financial and pharmaceuti-
cal transaction workflows, both within and between healthcare enterprises. The Suite includes business perfor-
mance management applications that automate and manage the full lifecycle of transactions from community
enablement, to testing and data validation, real-time transaction monitoring, claim repair and reconciliation
facilitating direct connectivity and providing rich transaction analytics.

Business Performance Management Applications

Edifecs Ramp Management for Trading Partner Edifecs Transaction Management analyzes this informa-
On-Boarding tion, which is then stored in Edifecs Healthcare Transac-
The Edifecs trading partner ramp solution helps take the tion Repository (HTR) to provide a complete picture of
headache (and expense) out of bringing up new trading the transaction lifecycle, to automate error management
partners. Trading partner ramp can be time-consuming, and exception handling, and to deliver timely information
tedious and expensive. The Edifecs solution streamlines directly to the people who need to take action.
the process by enabling your trading partners to test
directly against your companion guides and business Edifecs Claims Correction for Claims Editing
requirements online. By automating testing and other
Edifecs Claims Correction allows you and your trading
manual tasks, it helps free your staff to focus on more
partners to view claims-related EDI transactions online
strategic priorities. And by providing detailed, instanta-
through a business user-friendly interface. Based on your
neous feedback to your trading partners, it can dramati-
configured rules, trading partners and/or your designated
cally reduce the time it takes them to resolve issues,
internal users are able to correct known errors in the
allowing a quicker transition to production.
data that would otherwise prevent claim acceptance.
This ability to identify errors and allow correction online
Edifecs Transaction Management for Visibility where appropriate, can significantly increase the first pass
into the Transaction Lifecycle
rate for your processing systems, reduce claim resubmis-
Edifecs Transaction Management ensures operational sion and improve relationships with your trading part-
integrity and accountability in the transaction lifecycle ners. All correction activity is fully audited with linkages
by tracking both real-time and batch transactions and of all corrected data to the unaltered original transaction.
associated business or system events at each of the key
processing points in your enterprise.

page 8 of 12 Edifecs XEngine


Tools and Technologies

Edifecs SpecBuilder for Guideline Authoring Edifecs CommerceDesk Framework


Edifecs SpecBuilder is the industry standard for guide- Edifecs CommerceDesk Framework provides portal
line authoring, publishing and desktop testing. With the services, reporting, dashboards, partner management, user
richest library of transaction standards on the market, management and other common services for use by
Edifecs SpecBuilder allows you to define and document Edifecs business performance management applications.
the business requirements for your transactions, includ- By leveraging a single unified framework, you can quickly
ing specifying the business edits, code sets and other add new applications, ensure a single point of administra-
requirements important to the way your business works. tion, reduce training and support costs through a stan-
After your companion guides have been defined, they can dard human interface, and leverage common information
be used for both upfront testing and production valida- across applications.
tion with Edifecs XEngine. They can also be distributed
to your trading partners in both human-readable and
machine-readable formats to simplify their implementa-
tion process. Edifecs SpecBuilder also includes guideline
migration, standards repository and test data generator
components.

Edifecs Healthcare Transaction Repository (HTR)


The Edifecs Healthcare Transaction Repository (HTR)
provides a centralized location to store transaction audit
information, error results, and key indexes and metrics.
Data is stored in a set of relational database tables that
have been specifically structured for query and analysis.
The Transaction Repository is populated by the validation,
splitting, routing and acknowledgement components.
The data is then read from the transaction repository
by the dashboard, error analysis, and transaction center
components.

Edifecs XEngine page 9 of 12


NOTES

page 10 of 12 Edifecs XEngine


NOTES

Edifecs XEngine
About Edifecs,Inc.

Edifecs helps organizations achieve interoperability and dramatic return


on investment by enabling, managing and deriving business value from
standard electronic transactions within trading partner communities.

Edifecs products include the Edifecs Healthcare Suite a set of powerful


applications and technologies that reduce friction in the administrative,
clinical, financial and pharmaceutical transaction workflows, both within
and between healthcare enterprises. The Suite includes business
performance management applications that automate and manage the
full lifecycle of transactions; from community enablement, to testing
and data validation, real-time transaction monitoring, claim repair and
reconciliation, facilitating direct connectivity and providing rich trans-
action analytics.

Edifecs provides Global Markets product solutions for guideline authoring,


data validation and partner enablement to manage, analyze
and enforce the quality of transactional data being exchanged with a
trading partner community.

2006 marks 10 years of Edifecs leadership and expertise in providing


innovative technology solutions to over 1600 customers worldwide.
Edifecs has over 300 customers and partners in healthcare that include
16 Blue Plans, 35 Medicaid, State and Federal Agencies, along with
partnership arrangements with all leading middleware stack vendors.
Founded in 1996, Edifecs is headquartered in Bellevue, WA.

16625 Redmond Way, #468 Redmond, WA 98052


(425) 452-0630
info@edifecs.com
www.edifecs.com
Edifecs XEngine
page 12 of 12 page 9 of 12