HIPAA Electronic Claims Processing
 
 



Customer Overview:

The Military Medical Support Office (MMSO) provides medical and dental claims processing and customer service for eligible United States Department of Defense Active Duty Military and Reserve Service Members.

 

Needs:

MMSO needed to enhance its its Claims Processing (CPSII) system to send and receive electronic transactions to comply with HIPAA (Health Insurance Portability and Accountability Act) requirements.

 

Solution:

QFlow enhanced CPSII to support automated processing of the following HIPAA electronic transactions:

  • 270/271 Eligibility Inquiry and Response
  • 837/835 Claims Submission and Payment
  • 276/277 Claims Status Inquiry and Response

 

 The CPSII HIPAA-compliant application was successfully implemented in September 2003 prior to the mandated HIPAA implementation deadline.

 

Benefits:

MMSO's CPSII is fully compliant with mandated HIPAA requirements. HIPAA electronic transactions are processed without handling any paper. MMSO can process larger volumes of claims without increasing staff.

 

Services Provided:

QFlow designed the technical architecture for processing HIPAA electronic transactions. QFlow analyzed the HIPAA electronic transaction formats and the information captured by MMSO's claims processing system. QFlow designed and implemented the necessary modifications to the claims processing application to support HIPAA data requirements. QFlow also designed and developed a website to support MMSO's trading partners that want to send and receive electronic transactions

 

Technical:

− EDIFEC's XEngine HIPAA translation software;
− Microsoft Biztalk server;
− IBM FileNet Content Services;
− Kofax Ascent Capture;
− Oracle database; and
− Borland Delphi (existing claims processing application).