X12 is an older standard that HIPAA adopted primarily for insurance data exchange. Like with your elders, you should respect X12 since it serves a valuable purpose in the healthcare industry. X12 standardizes 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?), your organization needs a modernized solution for working with paradigms like X12 and HL7v2.
We simplify and automate processes that use X12 for data exchange. For example, say goodbye to manual workflows like faxing for preauthorizations. Redox can benefit customers on any side of the X12 data exchange, including:
- vendors
- providers
- payers
- clearinghouses
- preauthorization management companies
You can use these Redox API actions to normalize X12 data into FHIR® (and vice versa, to return X12 data back to non-FHIR® connections):
- 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 |