HIPAA Compliance

Compliance with HIPAA rules is essential in the exchange of EDI files. EDI standards are strict and precise; adherence to these standards is important so that any healthcare entity can work with them regardless of their back end system software.

Maintaining ongoing compliance of these mandates and eliminating trading partner complaints, can still be an operational challenge in the healthcare industry. After more than 20 years of experience in the industry, we have seen a high amount of EDI files that get rejected because of compliance issues. Many trading partners reject EDI files with compliance errors, and this can even result in the suspension of the trading partner. That is why all HIPAAsuite software include a built-in EDI HIPAA compliance engine that checks all incoming and outgoing files.

That is why all HIPAAsuite software has a HIPAA compliance check for all incoming and outgoing files. Our EDI Exchange module has a built-in compliance engine that uses so called SEF files, (Standard Exchange Format), which codify the transactions that each standard contains. EDI Exchange handles the full E-commerce  communication protocol with Functional Acknowledgments (999), Transaction Acknowledgments (TA1) and automated flow.

But we had many inquiries from our clients and others working in EDI for a stand-alone compliance checker that does not need much of a set-up and can be operated by anyone. We decided to marry our EDI Editor with the compliance engine of EDI Exchange and created the HIPAA Compliance Editor.

For the longest I was envisioning a tool that would do a compliance check of an EDI file in the Editor. An Editor that would highlight the errors and when you click on the high-lighted section the full error message will show. The editor will allow you to fix the file and rerun the compliance check, letting you fix the file with confidence or understand what was done wrong. Find, Replace, Copy, Cut and Paste are all available to help in Editing a file.

In addition to the color editor the HIPAA Compliance Editor creates a written report on a single file or on many files. This way one can competently communicate about compliance issues with trading partners and others. The report comes in a variety of formats, Microsoft Word (docx) for human consumption, Microsoft Excel (xlsx), XML and Json for machine consumption.

The HIPAA Compliance Editor sorts files into ones that pass the compliance check and ones that are Rejected. When processing a directory of EDI files, one has the option to sort the files into 2 folders, 'Pass' and 'Reject'.