Requirement prior to bidding experience with HIPPA X12 EDI solutions. You must have a current solution or one that you built. I can purchase one you built. You need to work minimum supervision and deliver. Must have EDI x12 knowledge.
1) EDI 837 I/P MAPPING -- Mapping Tools to Map in EDI files from different vendors so the system can load the data. This mapping tool should be configurable and GUI interface preferably.
2) GENERATION OF 999 / 277 / TA1 -- Validation of the EDI files needs to happen up front if the file is bad or if needed later on in any of the steps below the ability to generate 999/277/TA1 to be generated automatically.
3) FLATTENING OUT 837s JASON FORMAT (ability to create 1500/ub PDF forms from the data submitted)
LOADING INTO SQL SERVER – SQL Tables should be detailed with specific fields, instead of blub these fields will allot validation for members, providers, coding, diags and other fields.
Once data is loaded into SQL server, we have to track:
File Name, Received date, load date ...
On the File Name (since 1 file might have 100 or 1000 claims) status Fields
Example Statuses :
Missing – Member ,
Missing Provider ,
5) AFTER LOADING TO SQL VALIDATION WILL BE DONE (back end sql queries developed by us which will update "status" field based on that later steps to generate 837 or send out errors member not found to the submitter see Step 2)
7) VALID RECORDS FROM DATABASED CONVERTED BACK TO 837 FORMAT (to be loaded into core system) ability to retain original file name, and/or business logic to change file name with prefix/suffix.
ENCOUNTERS OUTGOING :
1) REFERENCE SQL DATABASE ABOVE TO IDENTIFY CLAIMS TO BE SUBMITTED AS ENCOUNTERS
2) MAPPING UTILITY FROM SQL BACK TO 837 I/P FILE GENERATION ( includes validation to make sure its valid 837)
3) CREATING TABLE PRIOR TO 837 I/P GENERATION
4) GENERATING 837 FROM STEP 3
sample utilities open source.
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Need full VS files, with any licenses or DLLs that will help edit the project in any way on our end. Ideally, you did this and you need to tweak your process. Please do not bid if you have no experience, also please message share a sample of screenshots with obfuscation of work done that can be reused or rebuilt for this.