BizTalk 2006 R2 - Hospital HIPAA Accelerator

Project Purpose
This project provides a basis for understanding how BizTalk Server 2006 R2 handles HIPAA processing. This solution also demonstrates the capability for hospitals to achieve a faster adjudication on thier claims and a reduction in thier processing times by using a 3rd party claims processor called Availity http://www.availity.com. The following messaging patterns are demonstrated:

• 837 Institutional Claim Submission in Batch and Realtime
• 835 Payment
• 270 Eligibility Request
• 271 Eligibility Response
• Ability to use a HIPAA Preprocessor for working with non validating Claims (http://www.edifecs.com)

Reporting for the claim submission can be accomplished in 2 ways:

• Realtime reporting using a ROLAP Cube and SQL 2005 Reporting Services
• Trend reporting using a MOLAP Cube and Excel or SQL 2005 Reporting Services

HighLevel Overview Diagram:

Reporting Overview:

SharePoint Dashboard:


Excel Analysis:


Please see the Overview document and PPT available in the Releases section. Questions should be posted in the Discussions tab.

Dan Sandlin
Solution Specialist - Microsoft
DanSand@microsoft.com