EDI In Healthcare:

Nitor Capabilities

EDI service landscape

834 – Insurance eligibility and benefit verification Paper based claims submission – UC05, CMS1500

837 - Claims information 835 – Remittance advice

999 - Acknowledgment

Generation and verification of EDI 837P and EDI 837I file from flat file

Parsing EDI 835 file and converting it to simple readable flat file

Conversion from flat file to EDI format

To map data from flat file to EDI format

Report generation

Healthcare domain

knowledge

Business Intelligence &

Analytics

Product Engineering Mobility

Healthcare testing

En

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Nitor’s capabilities in EDI transition

iOS App• Generating EDI 837P and EDI 837I file from flat file received from various providers

to be submitted to payer

• Parsing EDI 835 file received from payer and converting it to simple readable flat file and entering the same in database so that reports could be generated easily

• Generating EDI 834 file and sending the same to the payer for benefit and eligibility verification

• Support conversion of messages between many different formats, such as, X12, EDIFACT, XML, Proprietary formats (SAP IDOCs, JDE formats, etc) and also map directly to Databases

• Convert flat file data into EDI format

• Parse the EDI file received in desired format like flat file, .doc etc

• Map data from flat file to EDI format

Data handshake during development: Masking for Compliant Engagement

• Masking PHI data to maintain confidentiality• Maintaining Audit compliance – To maintain user wise for data

accessed, data shared, login time, logout time etc)

We need data for testing

/execution

Because of HIPAA, you can

not provide us with REAL

data

Data can not cross

US boundary

Nitor Provides

you “MASKER”

You MASK data at

your place

You make the data –

“non-decipherab

le”

Nitor gets Data for testing

that can not be

IDENTIFIED

Compliant Engagement

Services and

Capabilities

• Secure interoperability while sharing sensitive data• Copy sensitive data outside your production environments

• Move your development to the cloud or offshore• Need regulatory or audit compliance (i.e.- HIPAA, Dodd-Frank)• Interoperability among ACO & HIE participants