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:

HighlevelFlow.jpg

Reporting Overview:

ReportingFlow.jpg

SharePoint Dashboard:
Dashboard.jpg

Excel Analysis:
Excel.jpg

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

Last edited Jan 10, 2008 at 11:12 AM by DanSand, version 16