EDI Healthcare Suite

EDI Healthcare Suite

The EDI Healthcare Suite is a comprehensive, enterprise-grade platform purpose-built for healthcare organizations that need to exchange electronic data with payers, clearinghouses, and trading partners. From enrollment processing to claims adjudication, the suite handles every stage of the healthcare EDI lifecycle with full HIPAA compliance.

Enrollments Module

Streamline the member enrollment process with automated 834 Benefit Enrollment and Maintenance transaction processing. The enrollments module handles initial enrollments, changes, terminations, and reinstatements — reducing manual data entry errors and accelerating onboarding timelines.

• Automated 834 transaction generation and processing
• Real-time member eligibility synchronization
• Bulk enrollment file processing with validation
• Audit trail for all enrollment changes
• Configurable business rules for enrollment workflows

Claims Module

Process healthcare claims with speed and accuracy using our integrated claims engine. The module supports both professional (837P) and institutional (837I) claim formats, with built-in validation to catch errors before submission.

• 837P and 837I claim generation and submission
• 835 Electronic Remittance Advice processing
• Automated claim status inquiry via 276/277 transactions
• Denial management and resubmission workflows
• Real-time claim tracking dashboards

WEDI SNIP 7-Level Validation

Every transaction passes through our rigorous WEDI SNIP validation engine, ensuring compliance at all seven levels before data ever leaves your organization.

• Level 1 — EDI Standards Integrity Testing
• Level 2 — HIPAA Implementation Guide Requirements
• Level 3 — Inter-Segment Situation Testing
• Level 4 — Trading Partner-Specific Testing
• Level 5 — External Code Set Testing
• Level 6 — Trading Partner Agreements
• Level 7 — Claim Status & Coordination of Benefits

HIPAA Compliance

The suite is built from the ground up for HIPAA compliance, supporting all mandated transaction sets including 837, 835, 834, 270/271, 276/277, and 820. Encryption, access controls, and comprehensive audit logging ensure your data remains secure and your organization stays compliant.