BizTalk 2013 EDI for Health Care: HIPAA-Compliant 834 (Enrollment) and 837 (Claims) Solutions (2014)

Introduction

The Affordable Care Act (ACA) has had massive impacts on the health care industry, and many of today’s headlines are directly related to the 834 EDI document type. All of the data integrations behind the highly visible federal and state exchanges start with enrollment and the maintenance (effectuation/reconciliation/etc.) of that enrollment data. When a user signs up for coverage via one of these websites, their data is transmitted to insurance providers using the 834 format. The 834 is ubiquitous within health care back-end systems, and knowledge of it is critical to an IT professional’s ability to operate successfully within this industry. BizTalk provides an obvious integration platform and EDI engine for these types of integrations.

Specifically as it relates to 837s, there is an immense need within the claims management industry to build highly efficient EDI processing systems that are cost effective and easy to maintain and extend. BizTalk is emerging as the leading technology applied in this space due to its low initial cost and the relative ease with which it can be adopted into infrastructures that are Microsoft based. While the ramp-up to be highly proficient with the tool may be high, building your own fully HIPAA-compliant solution is completely achievable.

My objective in this book is to lay out a variety of patterns for implementing specific EDI Health Care—based BizTalk solutions, so that you—whether you are an executive, an architect, or a developer—can see all the components required and understand exactly what needs to be developed to build your own specific implementation. My hope is that you can accurately assess the skills required, the amount of time necessary, and the complexity of the tasks ahead, and that you can enter into the development of your solution with a clear idea of what is required to be successful.

A website dedicated to the application of BizTalk within the health care profession can be found at http://www.biztalkforhealthcare.com. You will find an array of topics, both technical and business focused, discussed on this site. You can also visit my site athttp://www.inotekgroup.com.