Every day tens of thousands of encrypted data transactions occur between health care providers, pharmacies, insurers, medical billing services, and employers who provide worker health coverage. Everyone in the United States covered by health or dental insurance depends on the automation, accuracy, and security of these largely unnoticed data streams to verify eligibility and process payments for nearly all medical services.
Definition of messaging standards for these transactions are mandated by HIPAA (Health Insurance Portability and Accountability Act), passed in 1992 and administered by the Department of Health and Human Services. By January 1, 2012, all health care enterprises covered under HIPAA are required to transfer data in version 5010, the latest HIPAA standard, based on ANSI X12.
Migrating Existing Data Formats To and From the Latest Standards
Altova MapForce is a powerful and flexible tool used by developers and IT professionals in many industries to automate today’s complex data conversions. The screenshot below shows a portion of a real-world example of a complex HIPAA data mapping in Altova MapForce from one state’s ANSI X12 eligibility file to integrate membership file data for public sector healthcare.