Mark Beckner - BizTalk 2013 EDI for Health Care: HIPAA-Compliant 834

BizTalk 2013 EDI for Health Care

HIPAA-Compliant 834 (Enrollment) and 837 (Claims) Solutions

Mark Beckner

BizTalk 2013 EDI for Health Care: HIPAA-Compliant 834 (Enrollment) and 837 (Claims) Solutions

An Apress Advanced Book

Copyright 2014 by Mark Beckner

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ISBN-13 (pbk): 978-1-4302-6607-5

ISBN-13 (electronic): 978-1-4302-6608-2

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President and Publisher: Paul Manning

Lead Editor: Steve Weiss

Editorial Board: Steve Anglin, Mark Beckner, Ewan Buckingham, Gary Cornell, Louise Corrigan, James T. DeWolf, Jonathan Gennick, Jonathan Hassell, Robert Hutchinson, Michelle Lowman, James Markham, Matthew Moodie, Jeff Olson, Jeffrey Pepper, Douglas Pundick, Ben Renow-Clarke, Dominic Shakeshaft, Gwenan Spearing, Matt Wade, Steve Weiss

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To my boys: may you stay healthy and insured and not have your information transported in an 834.

Mark Beckner

Contents at a Glance

Contents

About the Author

Mark Beckner is a technical consultant specializing in business strategy and enterprise application integration. He runs his own consulting firm, Inotek Consulting Group, LLC, delivering innovative solutions to large corporations and small businesses. His projects have included engagements with numerous clients throughout the United States, and range in nature from strategy and business architecture to development of complete integration solutions. He has authored BizTalk 2013 EDI for Supply Chain Management, BizTalk Recipes, Pro EDI in BizTalk Server 2006 R2, and Pro RFID in BizTalk Server 2009, and has spoken at a number of venues, including Microsoft TechEd. In addition to BizTalk, he works with Microsoft Dynamics CRM, SharePoint, and custom .NET development. Beckner, his wife Sara, and his boys Ciro and Iyer Blue live somewhere in the rugged deserts and/or mountains of the American West. His website is .

Introduction

The Affordable Care Act (ACA) has had massive impacts on the health care industry, and many of todays headlines are directly related to the 834 EDI document type. All of the data integrations behind the highly visible federal and state exchanges start with enrollment and the maintenance (effectuation/reconciliation/etc.) of that enrollment data. When a user signs up for coverage via one of these websites, their data is transmitted to insurance providers using the 834 format. The 834 is ubiquitous within health care back-end systems, and knowledge of it is critical to an IT professionals ability to operate successfully within this industry. BizTalk provides an obvious integration platform and EDI engine for these types of integrations.