Translating X12 to FHIR

X12 is an older standard that HIPAA adopted primarily for insurance data exchange. Similar to your elders, you should respect X12 as it serves a valuable purpose in the healthcare industry to standardize administrative data in and between major players, like healthcare organizations and payers.

However, as the industry strives for better interoperability, and FHIR® starts to spread (see what we did there?), organizations like yours need a solution that modernizes your approach to working with paradigms like X12 and HL7v2.

Translating to FHIR
Translating to FHIR

Who needs to translate X12

We help you simplify and automate your processes that currently use X12 data exchange; for example, say goodbye to manual workflows like faxing for prior authorizations. Redox can benefit customers on any side of the X12 data exchange, including:

  • Health tech vendors
  • Healthcare organizations
  • Payers
  • Clearinghouses
  • Prior authorization management companies

Redox API actions

With Redox, you can use these API actions to normalize X12 data into FHIR® (and vice versa, to return X12 data back to your non-FHIR® connections):

  • Manage prior authorizations
  • Request coverage eligibility status
  • Manage claim submission to payer or clearinghouse
  • Check status of a submitted claim

Translated FHIR® operations

To get into the nuts and bolts, we help you normalize these X12 messages into FHIR® operations:

X12 message
Description
FHIR® operation
270
Find out what's included in a patient's insurance coverage before offering services.
coverageEligibilityRequest/$submit
271
Respond with a patient's eligibility information to the requesting healthcare organization.
coverageEligibilityResponse/$respond
275
Exchange additional patient information for a prior authorization.
claim/$attach
276
Check the status of a previously submitted claim.
claim/$status
277
Respond with the status of a submitted claim.
claimResponse/$status-response
278
Request an approval for a prior authorization request.
claim/$submit-preauthorization or claim/$submit
278
Respond with an approve/decline to a prior authorization request.
claimResponse/$respond
835
Respond with payment for a submitted claim.
claimResponse/$payment
837P
Submit a claim for professional billing (i.e., provider time or services during an outpatient visit).
claim/$submit-professional
837I
Submit a claim for institutional billing (i.e., nursing care, services, medications, or supplies used during an inpatient visit).
claim/$submit-institutional