| Redix International

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 Name	Source Message Type	Target 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.