Concepts

The HIPAAsuite RealTime Client is a communications client designed to interact with SOAP and MIME services. This makes HIPAA Authorizer able to request and receive EDI files, in turn enabling providers of health care services to check whether a patient is covered by a health insurance policy electronically. The client will package and send EDI 278 files and receive the 278 response transaction files using secure http as a transport medium. The RealTime Client is also capable of sending unencrypted test-only messages for use in a testing environment, however in a production environment they will be sent via https. This means every service needs an SSL Certificate signed by a recognized certificate authority and every EDI message sent through https will be sent encrypted and can only be decrypted by its intended recipient.

With the Affordable Care Act's (ACA or Obamacare) adoption of the EDI connectivity rules developed by the Coalition for Affordable Quality Healthcare (CAQH), a consortium of healthcare industry providers and insurers, the need. They devised and prescribed mechanisms to transfer eligibility information in real-time between two computers.These new CORE standards will greatly enhance the efficiency of establishing insurance coverage for a patient, reducing the wait time to under a minute. CAQH's CORE standards for administrative data exchange are rolled out in segments referred to as Phases. The HIPAA RealTime Client is CORE Phase II-certified, meeting all connectivity and data content rules specified therein.

The HIPAA Authorizer's RealTime Client requires EDI Exchange. It will allow you to send EDI 278 requests securely to the trading partner of your choice and process the resulting EDI 278 response file. Although named RealTime, the client does support batch mode EDI transfers for large or bundled eligibility requests.

Though the 278 transaction set is not yet mandated under the CORE rules we at HIPAAsuite feel that this technology could be beneficial to the exchange of authorizations between a provider and a UMO/payer.