Here at Redox, we’ve continued to expand our support for healthcare product teams looking to exchange data with payers. As organizations attempt to modernize healthcare administrative data, we believe our X12 Translation offering is the needed solution for organizations attempting to connect to clearinghouses, payers, and healthcare organizations that exchange data using the EDI X12 standard and legacy solutions.
X12 translation powered by Redox is the missing bridge that aims to standardize both administrative and clinical data, regardless of the source standard. With this bridge, an organization can focus their time on building better offerings for clients and less time doing manual data standardization. Harmonization of X12 into FHIR gives customers a single point of control and format for all of their data while allowing them to broaden their key partnerships with healthcare organizations.
Some benefits of X12 translation through Redox are:
- Connect once through Redox to many clearinghouses, payers, and healthcare organizations. One endpoint will simplify your workflows, making them scalable regardless of how complex your business needs are.
- Unify data insights by using FHIR for both clinical and administrative data while remaining CMS compliant. Seamlessly convert X12 to FHIR (and back again) for supercharged analytics, intelligence, and reporting.
- Modernize your workflows by removing significant back-and-forth and dealing with the myriad of healthcare data standards. Direct exchange using FHIR will decrease time to care and improve the clinician experience.
Why X12 Translation Matters
Imagine using modern FHIR APIs to build your healthcare solution – but only submitting claims to payers by fax. While fax is hopefully not the reality, payers do leverage the X12 data standard mandated 20 years ago, which isn’t exactly FHIR. Not only does this cripple your modern development efforts, but it complicates your workflows and increases the time it takes for a successful claim.
Having direct exchanges using FHIR removes manual back-and-forth and the possibility of mistranscription.
Our X12 translations offer the seamless exchange to FHIR for many workflows including:
- Claim Adjudication: Easily manage your claims process via a single endpoint that allows you to easily submit claims and receive payment for those claims that have already been submitted. Also, receive historical claim payments for analysis.
- Request Eligibility Check: Submit a request to the patient’s insurance to determine the patient’s eligibility. Receive a response back from the patient’s insurance with information like coverage, copayments, deductibles, and coinsurance.
- Request for Prior Authorization: Submit a request to the patient’s insurance for prior authorization for a procedure or medication. Receive a response back from the patient’s insurance.
- Check Claim Status: Better manage your collections process by inquiring about the status of submitted claims to understand when payment will be received for services already performed.
X12 translation to FHIR is just one step towards modernizing administrative healthcare data. Stay tuned for future updates as we will continue to add workflows and capabilities.
Want to learn more?
Replay Senior Developer Nick Hatt’s recent “X12 gets Lit” tech talk to dig deeper into Redox’s X12 to FHIR capabilities.
Ready to start translating X12 to FHIR?
Reach out today to get connected with a member of our solutions team and learn how you can take advantage of this offering today.