webMethods HIPAA Module

Release Notes

webMethods HIPAA Module Version 6.0.2

webMethods is pleased to introduce the 6.0.2 version of the webMethods HIPAA Module. Version 6.0.2 of the Module is a special minor release that provides customer-driven enhancements to a subset of HIPAA transactions -- 820, 834, 835 and 837-Institutional.

Modularized Validation

For the 820, 834, 835 and 837-Institutional transactions, the transaction validation services have been modularized to give users more granular control over the types of HIPAA validation (Types 1-5) that they want to implement for a specific partner and transaction.

Large File Handling Support

For the 820, 834, 835 and 837-Institutional transactions , the modularized validation services enable users to implement EDI Large File Handling (according to guidelines), thereby allowing users to process large, multi-megabyte EDI files.

Addendum Support

For the 820, 834, 835 and 837-Institutional transactions , validation services for the included transactions support the Addendum to the WEDI HIPAA Implementation Guidelines released in February 2003.

Improved Validation Reporting Through Error Code Handling

For the 820, 834, 835 and 837-Institutional transactions , in addition to the standard included Validation Reports, validation errors now generate a robust set of error codes that can be used for more complex, customized Validation Reports.

Improved Performance

Based on the new design, users should expect an improvement in performance for the HIPAA validation services for the 820, 834, 835 and 837-Institutional transactions.

Usage Guidelines: Version 6.0.2 versus 6.0.1

Customers who want to deploy all HIPAA transactions together at this time should consider using Version 6.0.1. Version 6.0.1 and 6.0.2 employ different architectures and should not be implemented in the same instance of webMethods Integration Server.

Use Version 6.0.2 when:

You are only processing 820, 834, 835 or 837-Institutional transactions
Large file processing and performance are extremely important, based on your transaction volumes
You want to do complex validation reporting
You need Addendum support for the 820, 834, 835 and 837-Institutional transactions

Use Version 6.0.1 when:

You need to implement all 11 transactions together, -OR-
You choose to implement the 7 transactions other than 820, 834, 835 and 837-Institutional in a separate instance to complement Version 6.0.2
You have relatively low transaction volumes
You do not have to have Addendum support or can implement the minor changes for Addendum support yourself

For information about previous releases of webMethods HIPAA Module 6.0.1, see the release notes for those releases, below.

webMethods HIPAA Module Version 6.0.1

webMethods is pleased to introduce the release of the webMethods HIPAA Module, version 6.0.1.

Built on top of the webMethods Integration Platform and the webMethods EDI Module, the HIPAA Module enables employers, payers, providers and clearinghouses to engage in processing medical claims transactions according to the HIPAA standard. It also allows HIPAA implementations to easily make use of the robust and comprehensive feature sets of the entire webMethods Integration Platform, including business process modeling, human workflow elements, and monitoring.

HIPAA Transaction Support

Full support for all 11 HIPAA transactions:

Eligibility Benefit Inquiry Request/Response – Batch and Real-Time (270/271)
Premium Payment (820)
Benefit Enrollment and Maintenance (834)
Claim Payment/Advice (835)
Claim Status Request/Response (276/277)
Services Review, Request/Response (278)
Claim (837 – Institutional, Professional, Dental)

Code Set Support

Format validation is implemented for all code sets specified in the HIPAA transaction Implementation Guidelines.
The webMethods HIPAA Module also includes support for non-medical and medical Code Sets (ICD-9-CM, CPT-4, HCPCS, NDC, NCPDP, etc.) used to validate transactions to Level 5, as defined by WEDI-SNIP guidelines.
Additional codes can be supported to customize validation to Level 6 and 7.

Unique Identifiers

Using Trading Networks, users can manage and use unique identifiers for providers, plans, employers and individuals as theses identifiers become mandatory.

TA-1 and 997 Support

The webMethods HIPAA Module fully supports HIPAA-defined success/failure notification of envelope errors via TA-1 technical acknowledgments. 997 functional acknowledgments also are supported to communicate syntax errors in HIPAA documents. In addition to these, detailed error reports are generated and sent to your HIPAA Administrator via e-mail.

Validation and Certification Support

Through our development partner, Softima, webMethods has successfully validated transactions 270, 271, 276, 277, 835, and all three versions of 837 (Institutional, Professional, Dental) through Claredi.

Claredi certification provides out-of-the-box support validation to Level 5, as defined by the WEDI-SNIP structured certification process. The webMethods HIPAA Module will be certified for every transaction supported by Claredi certification software.

Through the addition of code sets and validation customization, the webMethods HIPAA Module also is capable of Level 6 and 7 validation, as defined by WEDI-SNIP certification guidelines.

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