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How HIPAA Level 3 to 7 Validation can be achieved in BizTalk directly instead of the using third party tool like EDIFECES RRS feed

  • Question

  • Hi All,


    Actually we have claim processing system and  EDIFECS is used for HIPAA Validation and some reporting purpose with BizTalk but ,now my client is trying to reduce the maintenance cost and avoid to use  multiple integration tool ,for it he is planning to re- platform the architecture and  use either BizTalk or  EDIFECS  only

    I am trying to understand  what is the best way to implement other level of HIPAA validation in BizTalk instead of third party tool in order to utilize BizTalk as Enterprise level 

    your suggestion will be very helpful to propose the solution for it

    Thanks KK

    Monday, February 22, 2016 4:07 AM

Answers

  • Given all the options, my recommendation would be a BRE policy.

    However, the technical implementation is actually the smallest, and probably easiest thing.

    The bigger issue is that you customer has to identify and define exactly which rules must be validated.  There are potentially hundreds of rules but in reality, only 5 or 6 matter to their processes.  And keep in mind, most sites don't bother with WEDI/SNIP, adjudication is final arbiter no matter what.

    Balancing is the only rule I've ever been asked to implement beyond what BizTalk does out of the box...well, I think there were some Trading Partner specific situation but that happens with every situation and is not HIPAA related.

    • Proposed as answer by Angie Xu Thursday, March 3, 2016 2:23 AM
    • Marked as answer by Angie Xu Thursday, March 3, 2016 2:23 AM
    Monday, February 22, 2016 1:30 PM

All replies

  •  

    BizTalk officially supports level 1 and level 2 of HIPPA compliance validation (though it is arguable that levels 3 and 4 are met unofficially). If more levels of compliance are required you will need to create your level 2 complaint document in BizTalk and then deliver the final file to another application that will perform the additional level of validation.

    You can try and explore the feasibility of implementing the validation capabilities through different options including: 

    (1) an external validation web service provided by a partner such as Edifecs, 
    (2) additional rules created using .NET, 
    (3) use of other rules built within the customers HIPAA and business rules editing sub-systems, 
    (4) rules entered in the BizTalk Business Rules Engine (BRE), 
    (5) or a combination of these options.

    Refer: http://blogs.msdn.com/b/biztalkb2b/archive/2009/12/03/how-does-biztalk-server-2006r2-or-bts2009-support-the-hipaa-validations-known-as-wedi-snip-levels-1-through-7.aspx


    Rachit Sikroria (Microsoft Azure MVP)

    Monday, February 22, 2016 7:23 AM
    Moderator
  • Given all the options, my recommendation would be a BRE policy.

    However, the technical implementation is actually the smallest, and probably easiest thing.

    The bigger issue is that you customer has to identify and define exactly which rules must be validated.  There are potentially hundreds of rules but in reality, only 5 or 6 matter to their processes.  And keep in mind, most sites don't bother with WEDI/SNIP, adjudication is final arbiter no matter what.

    Balancing is the only rule I've ever been asked to implement beyond what BizTalk does out of the box...well, I think there were some Trading Partner specific situation but that happens with every situation and is not HIPAA related.

    • Proposed as answer by Angie Xu Thursday, March 3, 2016 2:23 AM
    • Marked as answer by Angie Xu Thursday, March 3, 2016 2:23 AM
    Monday, February 22, 2016 1:30 PM
  • Thank you very much Johns for quick reply!!

    ,let me try to do POC with the help of BRE  and I think i need to understand the implementation guide with customer  and may be come once again if any help would be required .

    thanks KK.

    Tuesday, February 23, 2016 3:59 AM