Lilisoft Medical provides a solution to their customers that covers two major aspects of the healthcare system - a clinical information system and a HIPAA compli-ant claims processing system. The clinical information system organizes and stores the medical records of a clinic, while the HIPAA compliant claims processing system deals with the data capture and processing of claims. Lilisoft developed their own clinical information system internally, but sought outside expertise to develop their HIPAA compliant processing system.

The Challenge

To develop a HIPAA compliant processing system, Lilisoft had identified the following needs:

• generate HIPAA 837 transaction formats. Submit the transaction to a clear-inghouse over the Internet through secure communication.
• receive HIPAA 835 transaction formats from a payer. Extract the data to a SQL Server database.
• allow users to download HIPAA 835 for remittance advice. Users could also download HIPAA 277 for both acknowledgement receipts, pending notices, and remittance advice for claims.
• support HIPAA 270 and 271 for claim eligibility.
• process all files, including HIPAA and EDI data, automatically.
• run on Pentium 4, 2.8 GHz, 2 GB RAM and 80 GB HD.

The Solution

Lilisoft licensed the following Redix products:

• HIPAA package
• RMAP module

As claims were processed, Redix’s data conversion and validation process worked seamlessly within Lilisoft’s HIPAA compliant processing system, which made the Lili-soft solution fully automated.

The Results

All stages of implementation and testing were completed within a few months.
The Lilisoft HIPAA compliant processing system helped cut customers operating costs, boost efficiency, speed and responsiveness, met compliance deadlines, and developed new market opportunities. This integrated solution in the healthcare indus-try combined deep domain knowledge and proven HIPAA compliance technologies that enabled Lilisoft to conquer the unique challenges of the healthcare industry and to compete on a higher level.

David Hayes, owner of Lilisoft, summarized their overall experience with the Redix products and support as follows—“It (Redix) is robust, ... The Redix product served the need we were looking for and has lived up to that promise.”