B2B & Industry Data Standards

Supporting industry vertical standards

Santéon supports emerging standards for industry verticals to standardize data for exchange to improve efficiency and reduce costs. Santéon supports Business-to-business (B2B) transactions by providing pre-built schemas for industry verticals EDI standards.

HIPAA X12

Santéon provides full support for HIPAA X12 to simplify the electronic exchange of financial and administrative healthcare transactions. The Health Insurance Portability and Accountability Act (HIPAA) transactions standards will require all health plans, healthcare clearinghouses and healthcare providers to use or accept the electronic transactions listed below.

Santéon provides pre-built message structures for all HIPAA transaction types and supports the full six levels of HIPAA compliance. Additionally, Santéon provides pre-built forms with intelligence for HIPAA X12 transactions.

Encounter	X12 837	For submitting claim to health plan, insurer, or other payer.
Eligibility inquiry and response	X12 270 and 271	For inquiring of a health plan the status of a patient's eligibility for benefits and details regarding the types of services covered, and for receiving information in response from the health plan or payer.
Claim status inquiry and response	X12 276 and 277	For inquiring about and monitoring outstanding claims (where is the claim? Why haven't you paid us?) and for receiving information in response from the health plan or payer. Claims status codes are now standardized for all payers.
Referrals and prior authorizations	X12 278	For obtaining referrals and authorizations accurately and quickly, and for receiving prior authorization responses from the payer or utilization management organization (UMO) used by a payer.
Healthcare payment and remittance advice	X12 835	For replacing paper EOB/EOPs and explaining all adjustment data from payers. Also, permits auto-posting of payments to accounts receivable system.
Health claims attachments (proposed)	X12 275	For sending detailed clinical information in support of claims, in response to payment denials, among others.

Santéon supports all seven levels of HIPAA compliance.

Level 1 - Integrity Syntax Test
Level 2 - Implementation Guide Requirements
Level 3 - Balancing Testing
Level 4 - Situational Requirements
Level 5 - External Code Sets Testing
Level 6 - Product and Services Types
Level 7 - Trading Partner Testing

HL7

Health Level Seven (ANSI) standard for exchanging healthcare clinical and administrative data to improve clinical care and patient management.

GJXDM and GJXDD

Standard to increase the ability of justice and public safety communities to share justice information at all levels laying the foundation for local, state, and national justice interoperability. Global Justice XML Data Model (GJXDM) and Global Justice XML Data Dictionary (GJXDD) . Santéon has pre-built GJXDM message structure.

ACORD

Electronic standards for insurance, reinsurance, and related financial services, encompassing Life & Annuity, Property & Casualty, and Reinsurance.

SWIFT and SWIFTNet

Electronic standards and protocols for the financial services industry to reduce costs and ensure secure transactions.

RosettaNet

eBusiness standards to align processes between supply chain partners for secure and reliable business transactions.