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What does Redix HIPAA Package include?

The Redix HIPAA Package contains:

  • Redix AnyToAny Format Converter Engine
  • GUI Mapper with EDI Authoring Tools
  • HIPAA database, which incorporates all the HIPAA transaction sets:
  • 270/271: Health Care Eligibility/Benefit Inquiry and Information Response
  • 276/277: Health Care Claim Status Request and Response
  • 278 request/278 response: Health Care Services Review – Request for Review and Response
  • 834: Benefit Enrollment and Maintenance
  • 835: Health Care Claim Payment/Advice
  • 837: Health Care Claim: Institutional
  • 837: Health Care Claim: Dental
  • 837: Health Care Claim: Professional
  • Predefined maps between the HIPAA Professional Transaction Set and the HCFA standards:

?Map NameSource Message TypeTarget Message Type
HCFA_NSF_20_to_HIPAA_837_Prof_Outbound HCFA NSF Version 2.0 HIPAA 837 Professional 4010
HCFA_NSF_20_to_HIPAA_A1_837_Prof_Outbound HCFA NSF Version 2.0 HIPAA 837 Professional 4010A1
HCFA_NSF_31_to_HIPAA_837_Prof_Outbound HCFA NSF Version 3.1 HIPAA 837 Professional 4010
HCFA_NSF_31_to_HIPAA_837_Prof_Outbound HCFA NSF Version 3.1 HIPAA 837 Professional 4010A1
HCFA_WebMD_NSF_20_to_HIPAA_837_Prof_Outbound WebMD NSF Version 2.0 HIPAA 837 Professional 4010
HCFA_WebMD_NSF_20_to_HIPAA_A1_837_Prof_Outbound WebMD NSF Version 2.0 HIPAA 837 Professional 4010A1
HCFA_UB92_50_to_HIPAA_837_Inst_Outbound HCFA UB92 Version 5.0 HIPAA 837 Institutional 4010
HCFA_UB92_50_to_HIPAA_A1_837_Inst_Outbound HCFA UB92 Version 5.0 HIPAA 837 Institutional 4010A1
HCFA_UB92_50_OP_to_HIPAA_837_Inst_Outbound HCFA UB92 Version 5.0 (using Signed OverPunch) HIPAA 837 Institutional 4010
HCFA_UB92_50_OP_to_HIPAA_A1_837_Inst_Outbound HCFA UB92 Version 5.0 (using Signed OverPunch) HIPAA 837 Institutional 4010A1
HCFA_UB92_60_to_HIPAA_837_Inst_Outbound HCFA UB92 Version 6.0 HIPAA 837 Institutional 4010
HCFA_UB92_60_to_HIPAA_A1_837_Inst_Outbound HCFA UB92 Version 6.0 HIPAA 837 Institutional 4010A1
HIPAA_837_Prof_to_HCFA_NSF_20_Outbound HIPAA 837 Professional 4010 HCFA NSF Version 2.0
HIPAA_A1_837_Prof_to_HCFA_NSF_20_Outbound HIPAA 837 Professional 4010A1 HCFA NSF Version 2.0
HIPAA_837_Prof_to_HCFA_NSF_31_Outbound HIPAA 837 Professional 4010 ??HCFA NSF Version 3.1
HIPAA_A1_837_Inst_to_HCFA_NSF_31_Outbound HIPAA 837 Professional 4010A1 HCFA NSF Version 2.0
HIPAA_837_Inst_to_HCFA_UB92_50_Outbound HIPAA 837 Institutional 4010 HCFA UB92 Version 5.0
HIPAA_837_Inst_to_HCFA_UB92_50_Outbound HIPAA 837 Institutional 4010A1 HCFA UB92 Version 5.0
HIPAA_837_Inst_to_HCFA_UB92_60_Outbound HIPAA 837 Institutional 4010 HCFA UB92 Version 6.0
HIPAA_837_Inst_to_HCFA_UB92_60_Outbound HIPAA 837 Institutional 4010A1 HCFA UB92 Version 6.0
HIPAA_837_Inst_to_HCFA_UB92_50_OP_Outbound HIPAA 837 Institutional 4010 HCFA UB92 Version 5.0 (Using Singed OverPunch)
HIPAA_837_Inst_to_HCFA_UB92_50_OP_Outbound HIPAA 837 Institutional 4010A1 HCFA UB92 Version 5.0 (Using Signed OverPunch)

I noticed that in the Redix HealthCare EDI Authoring Tools, there are two messages defined for the HIPAA 837 professional, i.e., HIPAA_A1_837_Prof and HIPAA_A1_837_Prof_Outbound. I am wondering what the difference between the two messages is.

The HIPAA_A1_837_Prof message is the generic 837 professional definition defined in X12 4010. However, the HIPAA_A1_837_Prof_Outbound is a specific form of the 837 professional standard, based on HIPAA. The HIPAA_A1_837_Prof_Outbound has been rigorously defined in the usage of various segments and loops, and therefore, would eliminate the possibility of vagueness.

It is highly recommended that the user uses the HIPAA_A1_837_Prof_Outbound as the target message definition in order to generate a HIPAA 837 message. Use the HIPAA_A1_837_Prof as the source message definition to convert a HIPAA 837 file.

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