A c hi ev e tra n sa c ti on in tero p e ra b ility faster

Edifecs XEngine
Transaction Validation Solution

Dramatically improve your healthcare transaction automation

THE DNA OF B 2B

Edifecs XEngine
INTRODUCTION
In this time of increasing financial, operational and regula-
tory pressures on health plans, payers and providers, ex-
ecutives are discovering that electronic transactions pres-
ent as many challenges as they do opportunities. HIPAA
legislation mandated the use of standard transactions
and code sets between trading partners, in an attempt to
ease the burden of telephonic and paper communication
between payers, providers, employers and other stake-
holders. However, as almost everyone has discovered
many backend processes and systems have very specific
data content and format requirements, allowable under
HIPAA, in order to achieve the highest possible levels of
automation. Contrary to the intent of the law, in many
cases, automation rates have gone down, not upcreating
unintended costs and negative impacts for payers, provid-
ers and consumers.
HIPAA transactions are not the only standards that
healthcare organizations must support to be effective
and efficient. Other standards such as HL7, NCPDP, NSF,
UB92 and even proprietary file formats must be sup-
ported, given the wide variety of trading partner require-
ments. All these requirements have created a number
of questions that organization leadership should address
to be responsive to their markets. The answers to these
questions can determine whether an organization can
create and maintain a strategic advantage leveraging elec-
tronic trading relationships.
Edifecs XEngine in the Edifecs Healthcare Suite
page 2 of 12
Key Transaction-Related Questions
for Healthcare Organizations
What tools can I use to ensure that the data is compli-
ant not just with HIPAA, but with my business specific
requirements, and those of my trading partners?
Do I need different software systems for different stan-
dards such as HL7, NCPDP, and legacy file formats?
How will I manage, enforce, or relax edits and errors,
based upon the different needs of my trading partners?
Different types of submitters need to send different
types of data in the transactions. How will I manage to
ensure that I receive this data when I need it?
How can I split and route transactions once they hit my
firewall to the right adjudication system, to a carve-
out vendor, or even to separate good transactions from
bad transactions?
How will I generate the appropriate acknowledgments
and error messages when bad transactions are re-
ceived?
How will I keep up with the standards and code sets as
they change and evolve, and with new standards as they
are implemented?
How can I serve up this EDI data for new value-added
applications in my organization without a huge amount
of translator maintenance and cost?
Edifecs XEngine
Edifecs XEngine EDI Adaptor for Key Benefits of XEngine
Healthcare:
Ensures operational integrity with clean, validated trans-
action data passed to and from your back-end systems,
Validate,Split,Route and Transform Your validated against existing standards such as WEDI-SNIP
Transactions for Maximum Automation
Types 1-6, or against your trading partner-specific
Edifecs, the leading provider of B2B solutions for transac- requirements
tion-based interoperability, addresses all of these ques-
tions with Edifecs XEngine, our market-leading produc- Provides rich reporting to you and your trading part-
tion validation technology. An integral part of the Edifecs ners for rapid error resolution
Healthcare Suite, Edifecs XEngine ensures interoperability Delivers a complete library of healthcare standards-
with trading partners by validating healthcare and Global HIPAA, HL7, NCPDP, support for proprietary positional
Markets transactions for syntax, semantics and trading and delimited flat file formats and XML-based format--
partner-specific business rules. With real-time edits and for true standards independence
filters on the data entering or leaving your enterprise,
Automates the generation of the acknowledgement
you are assured that your back-end applications and data
transactions- TA1, 997 and 824
warehouses, as well as those of your trading partners,
contain accurate and valid transaction data, and achieve Automatic conversion to XML format for all transac-
maximum transaction automation. tion types- reduces costs associated with maintaining
By moving your specific requirements in front of those complex mapping
backend systems, you can proactively catch and manage Provides a completely integrated design-time and run-
exceptions that will cause adjudication rates to fall. With time environment with Edifecs SpecBuilder design-time
Edifecs XEngine you can: tools
Validate production data for compliance with HIPAA, Scalable to even the most high-volume environments,
HL7, NCPDP or proprietary formats and rules, includ- with the most robust cross-platform support in the
ing WEDI SNIP Types 1-6 for HIPAA transactions out of market
the box
Rapid and flexible implementation options- install and
Validate that data against your Companion Guide spe- implement in a matter of days, through either stand-
cific edits, by trading partner or service type, before it is alone server or through the use of robust Java APIs
passed through to hit your backend systems
Relax edits for specific trading partners, to create warn-
ings, informational responses, or simply ignore the edit
Split and re-batch transactions in real-time: good from
bad, or based on content
Receive automated error reports in human readable
and XML formats to share internally or with trading
partners
Keep abreast of the latest transaction versions, as well
as over 60 code set updates through monthly execut-
able updates, and stay up-to-date with ICD-9, CPT-4,
NDC and SNFR-HIPPS codes
Automatically create acknowledgement messages such
as 997, TA1, 997 and 824 transactions
Automatically transform EDI data into XML, for
consumption by other systems or processes in your
organization

Edifecs XEngine Data Splitting and Routing

Edifecs XEngine page 3 of 12

WHY YOUR ORGANIZATION NEEDS EDIFECS XENGINE

To ensure ongoing operational data integrity, you need go Edifecs XEngine Human Readable
beyond pre-production and 3rd party testing. Healthcare Error Report Example
organizations need to include a validation engine as part
Once your data is validated, Edifecs XEngine generates an
of their in-stream production data flow. While pre-pro-
EDI acknowledgment message to send back to your trad-
duction and 3rd party testing are a good first step in the
ing partner and also produces a rich machine and human
process to ensure that you and your trading partner can
readable report detailing the quantity, type, and severity
exchange files, they do not guarantee that all files coming
of errors found.
into your production system will meet your business
requirements.
The benefit of an in-line validation engine is that it will
check every data file. By catching errors as early in the
process as possibly, your organization will save time and
money associated with dealing with poor or corrupt data
ending up in your back-end system. Additionally, your
trading partners will be notified immediately as to the
cause and location of the errors in their original data file,
so that they can quickly fix the problem and resubmit the
data.
Edifecs XEngine can also validate data before it leaves
your organization, so you can verify that the data will
meet your trading partners business requirements.
Errors can be separated from valid transactions before
leaving the organization, ensuring that your trading part-
ner will not reject an entire batch of data because of few
errors. Edifecs XEngine Human Readable Error Report Example

HIPAA Transaction Validation for

Compliance
For entities covered under the federal HIPAA regulations,
compliance is mandated under federal law. For HIPAA,
Edifecs XEngine works in conjunction with you existing
translation package. Edifecs XEngine provides full compli-
ance checking against all HIPAA implementation guideline
rules, as well as your trading partner-specific require-
ments:
WEDI SNIP Types 1-6
Your own or your trading partners Companion Guide Edifecs XEngine Machine Readable Error Report Example:
edits (WEDI-SNIP type 7) 824 Acknowledgement

60+ External code sets, updated monthly

Correct Coding Initiative (CCI) edits
For incoming data, Edifecs XEngine is placed prior to
your translation system, so only HIPAA compliant data is
passed to your down-stream systems. For outgoing data,
Edifecs XEngine is placed after the translation software
so any errors can be caught before sending the data to
your trading partner, providing you the opportunity to fix
errors prior to data leaving your organization.

page 4 of 12 Edifecs XEngine

Messaging Screening, Filtering and
Splitting
In addition to data integrity and transaction compliance
checking, Edifecs XEngine can also screen and filter out
the bad data from the good data. The filtering can be
done at various levels based on your business needs- by
transaction or at logical business unit level such as Payer,
Subscriber, or Claim. By processing as much good data as
possible, re-submission costs will be reduced significantly
because only the bad data needs to be re-submitted. This
capability saves you time and money whether you are a
payer, provider, clearinghouse or vendor.
Edifecs XEngine Splitting Scenario Examples
Edifecs XEngine
Application Data Routing
In addition to filtering good data from bad, Edifecs
XEngine can also be used as an application data router.
Because it is part of the front-end process doing valida-
tion, Edifecs XEngine can look at the data content and
use information such as file type, transaction type, trading
partner, purpose, or even member or provider ID, to
route the data to appropriate downstream applications.
This functionality has many uses in any healthcare
enterprise:
It can be used to route data to different back-end
systems such as different claim adjudication systems for
different receivers or payer IDs.
It can be used to distinguish between real-time and
batch transactions and route the data to the appropri-
ate servers to provide proper load balancing and meet
required response times.
It can be used to prioritize transaction processing
eligibility transactions may be more critical than claim
transactions, etc.
page 5 of 12
Transaction and Data Format
Conversion
In addition to compliance checking and message filtering,
Edifecs XEngine also provides the ability to convert data
from its native format such as EDI, NSF, HL7, etc. To an
equivalent XML format.
Some of the key benefits of being able to get the data in
XML format include:
No need to write code or develop applications to
understand the various native formats. Edifecs XEngine
provides the pre-built parsers for these formats out of
the box.
No need to keep up to date with ongoing standards
changes such as new releases of code sets, HIPAA
v5010, Claims Attachments, NPI.
Leverage free, open source third party tools such as
Xerces and other XML parsers to read the entire
document, or use XPath to extract just some key values
from the document.
Leverage additional new technologies that have been
developed for XML and now apply them to other file
formats. For example, use style sheets (XSLTs) to pres-
ent the converted native data to your users in a friendly
and easy to use manner.
Edifecs XEngine XML Conversion Example
page 6 of 12
Supported Healthcare Standards
Edifecs XEngine supports more healthcare standards
than any other solution on the market. In addition to the
most robust standards support, Edifecs XEngine supports
the need that most healthcare organizations have for
proprietary formats that may be required due to internal
systems, or that a trading partner may need to achieve
interoperability with your organization. Supported stan-
dards include:
HIPAA X12 all mandated transactions and over 60
code sets, and support for 275 Attachment transactions
and 277U as these standards evolve
Standard X12
NCPDP Batch and Telecom
HL7- all 2.x versions and support for XML standards as
they evolve
NSF
UB-92
Delimited Flat File
Positional Flat File
And more!
Edifecs XEngine
Easy Installation and Flexible Implementation

Edifecs fully understands that Edifecs XEngine will be op-
erating within your larger enterprise integration eco-sys-
tem. Therefore, we provide you with an array of choices
as to how you would like to use Edifecs XEngine in your
environment.You are free to choose any of the following
integration options, and to mix and match different imple-
mentations for production vs. Test environments.
Java API
Edifecs XEngine exposes a full-featured, Java Interface
(using JNI) that you can wrap your own solution around.
This gives you greater flexibility in your choice of operat-
ing system environments, and lets you leverage the full
range of services that the J2EE environment offers to
integrate, deploy, and manage Edifecs XEngine with your
enterprise applications and with Web services-enabled
multi-tier enterprise applications.
COM API
Edifecs XEngines component object module (COM)
interface makes it possible for you to integrate Edifecs
XEngine in Windows environments.You can leverage
COMs integrated services and features, and use Edifecs
XEngine components with any of Microsofts program-
ming languages. Edifecs XEngines COM interface also
makes available to you the wide variety of .NET tools,
services, clients, and servers, which empower you to build
powerful software and systems through Web services.
Trading Partner Integration
Just as we provide many options for integrating Edifecs
XEngine in your environment, we also provide various
options for managing trading partner configuration. If you
already have an existing trading partner management sys-
tem, you can continue to use it through Edifecs XEngines
open architecture. By extending your infrastructure to
include guidelines needed for validation, you can leverage
your existing trading partner database system and keep
all trading partner information in a central repository.
Integration with your existing trading partner database
can be done either using COM or Java interfaces.
Alternatively, Edifecs XEngine also comes with a default
trading partner configuration file which can be used for
simple configurations. Edifecs XEngines built-in trading
partner module makes it possible for you to validate data
based on just the message type, or you can direct the
validation to be performed based on the specific sender/
receiver IDs and the type of data that was sent.

Command-line Executable
For some applications, the old standby of a command-
line execution still works the best. Business analysts and
non-programmers can use Edifecs XEngines standalone
command-line executable to validate and convert data
files quickly and easily without the need to write any
code.

Server Edition
Edifecs XEngine Server is ideal for those customers want-
ing to use the full-featured Edifecs XEngine without writ-
ing any code, yet still run it as an autonomous application.
Edifecs XEngine Server on Windows can be installed as
a Windows service and on non-Windows platform as a
daemon process. Edifec XEngine Server comes fully load-
ed with a thread pool library to manage multiple threads,
and a complete set of connectors to connect with IBM
Websphere MQ, SeeBeyond JMS, TIBCO EMS, Sun JMS,
FTP and simple file folders. Additionally, it allows you to
specify multiple pipelines so that you can have separate
processes for real-time vs. batch.

Edifecs XEngine page 7 of 12

RELATED PRODUCTS IN THE EDIFECS HEALTHCARE SUITE

Edifecs XEngine is tightly integrated with other Edifecs products in the Edifecs Healthcare Suite, a set of powerful
applications, tools and technologies that reduce friction in the administrative, clinical, financial and pharmaceuti-
cal transaction workflows, both within and between healthcare enterprises. The Suite includes business perfor-
mance management applications that automate and manage the full lifecycle of transactions from community
enablement, to testing and data validation, real-time transaction monitoring, claim repair and reconciliation
facilitating direct connectivity and providing rich transaction analytics.

Business Performance Management Applications

Edifecs Ramp Management for Trading Partner
On-Boarding
The Edifecs trading partner ramp solution helps take the
headache (and expense) out of bringing up new trading
partners. Trading partner ramp can be time-consuming,
tedious and expensive. The Edifecs solution streamlines
the process by enabling your trading partners to test
directly against your companion guides and business
requirements online. By automating testing and other
manual tasks, it helps free your staff to focus on more
strategic priorities. And by providing detailed, instanta-
neous feedback to your trading partners, it can dramati-
cally reduce the time it takes them to resolve issues,
allowing a quicker transition to production.
Edifecs Transaction Management for Visibility
into the Transaction Lifecycle
Edifecs Transaction Management ensures operational
integrity and accountability in the transaction lifecycle
by tracking both real-time and batch transactions and
associated business or system events at each of the key
processing points in your enterprise.
Edifecs Transaction Management analyzes this informa-
tion, which is then stored in Edifecs Healthcare Transac-
tion Repository (HTR) to provide a complete picture of
the transaction lifecycle, to automate error management
and exception handling, and to deliver timely information
directly to the people who need to take action.
Edifecs Claims Correction for Claims Editing
Edifecs Claims Correction allows you and your trading
partners to view claims-related EDI transactions online
through a business user-friendly interface. Based on your
configured rules, trading partners and/or your designated
internal users are able to correct known errors in the
data that would otherwise prevent claim acceptance.
This ability to identify errors and allow correction online
where appropriate, can significantly increase the first pass
rate for your processing systems, reduce claim resubmis-
sion and improve relationships with your trading part-
ners. All correction activity is fully audited with linkages
of all corrected data to the unaltered original transaction.

page 8 of 12 Edifecs XEngine

 Tools and Technologies

Edifecs SpecBuilder for Guideline Authoring Edifecs CommerceDesk Framework

Edifecs SpecBuilder is the industry standard for guide-
line authoring, publishing and desktop testing. With the
richest library of transaction standards on the market,
Edifecs SpecBuilder allows you to define and document
the business requirements for your transactions, includ-
ing specifying the business edits, code sets and other
requirements important to the way your business works.
After your companion guides have been defined, they can
be used for both upfront testing and production valida-
tion with Edifecs XEngine. They can also be distributed
to your trading partners in both human-readable and
machine-readable formats to simplify their implementa-
tion process. Edifecs SpecBuilder also includes guideline
migration, standards repository and test data generator
components.
Edifecs CommerceDesk Framework provides portal
services, reporting, dashboards, partner management, user
management and other common services for use by
Edifecs business performance management applications.
By leveraging a single unified framework, you can quickly
add new applications, ensure a single point of administra-
tion, reduce training and support costs through a stan-
dard human interface, and leverage common information
across applications.

Edifecs Healthcare Transaction Repository (HTR)

The Edifecs Healthcare Transaction Repository (HTR)
provides a centralized location to store transaction audit
information, error results, and key indexes and metrics.
Data is stored in a set of relational database tables that
have been specifically structured for query and analysis.
The Transaction Repository is populated by the validation,
splitting, routing and acknowledgement components.
The data is then read from the transaction repository
by the dashboard, error analysis, and transaction center
components.

Edifecs XEngine page 9 of 12

NOTES

page 10 of 12 Edifecs XEngine

NOTES

Edifecs XEngine
About Edifecs,Inc.

Edifecs helps organizations achieve interoperability and dramatic return

on investment by enabling, managing and deriving business value from
standard electronic transactions within trading partner communities.

Edifecs products include the Edifecs Healthcare Suite a set of powerful

applications and technologies that reduce friction in the administrative,
clinical, financial and pharmaceutical transaction workflows, both within
and between healthcare enterprises. The Suite includes business
performance management applications that automate and manage the
full lifecycle of transactions; from community enablement, to testing
and data validation, real-time transaction monitoring, claim repair and
reconciliation, facilitating direct connectivity and providing rich trans-
action analytics.

Edifecs provides Global Markets product solutions for guideline authoring,

data validation and partner enablement to manage, analyze
and enforce the quality of transactional data being exchanged with a
trading partner community.

2006 marks 10 years of Edifecs leadership and expertise in providing

innovative technology solutions to over 1600 customers worldwide.
Edifecs has over 300 customers and partners in healthcare that include
16 Blue Plans, 35 Medicaid, State and Federal Agencies, along with
partnership arrangements with all leading middleware stack vendors.
Founded in 1996, Edifecs is headquartered in Bellevue, WA.

16625 Redmond Way, #468 Redmond, WA 98052

(425) 452-0630
info@edifecs.com
www.edifecs.com
Edifecs XEngine
page 12 of 12 page 9 of 12