Payer Data Hosting Services

Developed for the payer community--including HMOs, PPOs, government programs, IPAs, MSOs, PHOs, and large medical groups--the MedData Payor Data Hosting Service provides absolutely everything you need to establish electronic EDI communication with your providers. The core business of MedData is the processing of real-time eligibility verification and other real-time healthcare EDI transaction sets. Our goal is to enhance a plan’s HIPAA support so that real-time transaction processing can be provided.

As an example regarding eligibility, MedData can receive copies of health plan membership, benefits and related eligibility data. This data may contain general coverage, managed care linkage parameters, co-payment, and other information as determined by the payer. The membership data received by MedData may be in any format that the health plan deems necessary. And the transfer protocol and frequency of update of the data is under the discretion of the plan.

When the data is received by MedData, we automate the translation process and place the data in our payer database server. This translation process prepares the data so that an eligibility request may be answered in a real-time mode. With this infrastructure, MedData is able to offer to a health plan the ability to become the plan’s HIPAA “business associate” for the processing of real-time eligibility verification transactions. MedData understands that many plans are preparing to support HIPAA 270/271 eligibility via a batch process. This does satisfy the HIPAA regulations for support of this transaction. However, in a practical sense, a batch process may not be satisfactory to some providers and may result in continued telephone calls to the plan. Our goal is to enhance a plan’s HIPAA support so that real-time transaction processing can be provided.

Real-time eligibility schematic for management of a health plan’s ANSI X12 270/271 real-time transactions:

1. The plan supplies MedData with membership data. The format and data supplied is under the control of the plan, as are the means of the data transfer and the frequency of update.
2. MedData translates the membership data so that it can be stored in its data warehouse.
3. A provider, either directly, or through its practice management system, or via a clearinghouse sends to MedData an ANSI 270 request. This request can be sent to MedData via a POS terminal connection, lease line, VPN, SFTP, real-time web service or through our Internet portal.
4. The ANSI 270 request is validated by our systems and we then process the request and return an ANSI 271 response to the provider via the chosen communication means.

Within this framework, MedData has the ability to process a single request or multiple requests either in sequential processing or a batch mode. And should any providers require translation services, MedData can accept a proprietary request and convert that into an ANSI 270.

In this process the health plan is able to support a real-time 270/271 process without the need to build a telecommunication infrastructure or a real-time processing engine. All that is necessary is for the plan to provide MedData with membership data and the supporting information. The fees for this service are individualized to meet the health plan’s model of how it expects to cover the cost of this HIPAA service. These fees may be charged to the provider or the plan and may be based on a monthly flat rate fee or a transaction fee.

For more information, please contact us at 1-877-633-3282