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.
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
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
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 |