🏆 CMS MANDATE READY

Our 278 Prior Authorization converter meets the CMS-0057-F Final Rule requirement for FHIR-based prior authorization APIs. Da Vinci PAS v2.1 compliant. Ready for the January 1, 2026 deadline.

HIPAA X12 to FHIR Transformation Package

The Redix HIPAA X12 to FHIR Transformation Package converts all 10 major HIPAA X12 EDI transaction types into FHIR R4 bundles.

Built on the proven Redix transformation engine with 30 years of healthcare integration experience, this solution provides production-ready conversion with real-time validation, comprehensive error reporting, and REST API integration.

The CMS 2026 Reality: Starting January 1, 2026, payers must support FHIR-based prior authorization. Our 278 converter is production-ready today, giving you time to integrate, test, and deploy before the deadline.

Quick Facts

  • ✓ 10 Transaction Types
  • ✓ FHIR R4 Compliant
  • ✓ CMS 2026 Ready
  • ✓ Da Vinci PAS v2.1
  • ✓ REST API Included
  • ✓ Sub-second Processing
Try Live Demo →

Supported Transaction Types

🏆 Prior Authorization (CMS Mandated)

  • 278 Request: Prior authorization requests to payers (Da Vinci PAS v2.1 compliant)
  • 278 Response: Authorization approval/denial responses

Eligibility & Benefits

  • 270: Eligibility, Coverage, or Benefit Inquiry
  • 271: Eligibility, Coverage, or Benefit Information Response

Claim Status

  • 276: Healthcare Claim Status Request
  • 277: Healthcare Claim Status Response

Claims Submission

  • 837 Professional: Healthcare Claim: Professional (CMS-1500)
  • 837 Institutional: Healthcare Claim: Institutional (UB-04)

Enrollment & Payment

  • 834: Benefit Enrollment and Maintenance
  • 835: Healthcare Claim Payment/Advice (Remittance)

Performance Benchmarks

Fast processing times tested on entry-level hardware (RedHat Enterprise Linux 9, 2 CPU cores, 4GB RAM):

Transaction Type Typical Complexity Processing Time
270/271
Eligibility		 5-15 segments
Patient + coverage info		 80-120ms
276/277
Claim Status		 10-25 segments
Claim inquiry/response		 100-150ms
278
Prior Auth		 20-50 segments
Auth request with clinical		 150-250ms
834
Enrollment		 15-40 segments
Member enrollment data		 120-200ms
835
Remittance		 30-100+ segments
Payment with adjustments		 200-400ms
837 Prof
Professional Claims		 40-80 segments
Physician claim with procedures		 250-350ms
837 Inst
Institutional Claims		 60-150 segments
Hospital claim with services		 300-500ms
Note: Performance on production systems with mid-range or high-end hardware will be significantly better. All times include full validation and FHIR resource generation.

FHIR R4 Resource Mapping

Each transaction type maps to appropriate FHIR R4 resources for seamless interoperability:

278 - Prior Authorization

  • Claim
  • ClaimResponse
  • ServiceRequest
  • Coverage
  • Patient, Practitioner, Organization

270/271 - Eligibility

  • CoverageEligibilityRequest
  • CoverageEligibilityResponse
  • Coverage
  • Patient, Organization

276/277 - Claim Status

  • ClaimResponse
  • Claim
  • Patient, Organization

834 - Enrollment

  • Coverage
  • Patient
  • RelatedPerson
  • Organization

835 - Remittance

  • ClaimResponse
  • PaymentReconciliation
  • Patient, Organization

837 - Claims

  • Claim
  • Patient, Practitioner
  • Organization
  • Procedure, Diagnosis

Key Features

Multiple Integration Methods

  • Web GUI with drag-and-drop
  • REST API
  • Command-line tools
  • Batch processing

Quality Assurance

  • HIPAA 5010 validation
  • FHIR R4 validation
  • Real-time error reporting
  • Comprehensive logs

CMS Compliance

  • CMS-0057-F compliant
  • Da Vinci PAS v2.1
  • FHIR US Core profiles
  • Jan 1, 2026 ready

What's Included

Software Components

  • ✓ HIPAA X12 to FHIR transformation engine
  • ✓ All 10 transaction type mappings
  • ✓ Web GUI with admin dashboard
  • ✓ REST API endpoints
  • ✓ Configuration files
  • ✓ Sample X12 files for testing

Documentation

  • ✓ Getting Started Guide
  • ✓ Installation Guide (Linux & Windows)
  • ✓ API Documentation
  • ✓ Transaction mapping specs
  • ✓ Troubleshooting Guide
  • ✓ CMS compliance documentation

System Requirements

Redix Engine redix64 executable (separate license required)
Python Version 3.9+ (for Web GUI)
Minimum Hardware 2 CPU cores, 4GB RAM, 10GB storage
Recommended Hardware 4+ CPU cores, 8GB+ RAM, SSD storage
Operating Systems Linux (RHEL 8/9, CentOS, Ubuntu 20.04+) or Windows (10/11, Server 2019/2022)

Try It Now - Live Demo

Test all 10 transaction types with sample files or your own X12 data.

Launch HIPAA X12 to FHIR Demo →

Service Packages

Package Description Best For
DIY Foundation Complete software, documentation, and sample files. Self-service implementation. Organizations with in-house integration expertise
Professional Services Foundation plus custom field mapping, testing, and deployment assistance. Standard implementations with moderate customization
Enterprise Package Complete turnkey solution including custom development, integration, training, and ongoing support. Complex environments requiring extensive customization

Why Choose Redix HIPAA X12 to FHIR?

✓ CMS 2026 Ready

Production-tested 278 converter meets CMS-0057-F requirements

✓ Complete Coverage

All 10 major HIPAA transaction types supported

✓ Da Vinci Compliant

PAS v2.1 implementation guide support

✓ Proven Technology

Built on 30 years of Redix transformation engine reliability

✓ Fast Processing

Sub-second conversion for most transaction types

✓ Flexible Integration

Web GUI, REST API, and command-line interfaces

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Note: This product requires a valid Redix Format Converter Engine license. Contact us for licensing options.