X12 is the HIPAA-adopted standard for exchanging insurance data. Like with your elders, you should respect X12 since it standardizes administrative data among healthcare organizations and payers.
As the industry strives for better interoperability, though, you need a modernized solution for working with a paradigm like X12.
We simplify and automate processes that use X12 for data exchange. For example, say goodbye to manual workflows like faxing for prior authorizations. Redox can benefit customers on any side of the X12 data exchange, including:
- vendors
- providers
- payers
- clearinghouses
- prior authorization management companies
You push X12 data with Redox FHIR® writeback operations to a cloud destination. Then, you can access the data with FHIR® whenever you need.
With X12 translation, you can perform these Redox API actions with FHIR®:
- Request coverage eligibility status
- Manage claim submission to payer or clearinghouse
- Check status of a submitted claim
Check out which X12 messages we normalize below.
X12 message | Description | FHIR® operation |
|---|---|---|
270 | Find out what’s included in a patient’s insurance coverage before offering services. | CoverageEligibilityRequest/$submit |
271 | Respond with a patient’s eligibility information to the requesting healthcare organization. | CoverageEligibilityResponse/$respond |
275 | Exchange additional patient information for a prior authorization. | Claim/$attach |
276 | Check the status of a previously submitted claim. | Claim/$status |
277 | Respond with the status of a submitted claim. | ClaimResponse/$status-response |
278 | Request an approval for a prior authorization request. | Claim/$submit-preauthorization or Claim/$submit |
278 | Respond with an approve/decline to a prior authorization request. | ClaimResponse/$respond |
835 | Respond with payment for a submitted claim. | ClaimResponse/$payment |
837P | Submit a claim for professional billing (i.e., provider time or services during an outpatient visit). Learn how to send a test 837 message in the Redox dashboard. | Claim/$submit-professional |
837I | Submit a claim for institutional billing (i.e., nursing care, services, medications, or supplies used during an inpatient visit). Learn how to send a test 837 message in the Redox dashboard. | Claim/$submit-institutional |