About X12 HIPAA

B2B for Oracle Integration supports the X12 HIPAA standard to exchange documents over the internet. X12 HIPAA is a subset of the X12 standard and is used in the healthcare industry for the exchange of data about health insurance claims and payments.

B2B for Oracle Integration translates inbound X12 HIPAA messages into XML format for processing and converts XML to X12 HIPAA version 2 format for outbound delivery. You create an X12 HIPAA schema and document and a trading partner in which the document can be used in both inbound and outbound agreements.

You define an AS2 Adapter as a trigger and invoke connection to handle X12 HIPAA data. The AS2 Adapter provides the following capabilities:

• Trigger (inbound) direction:
  • The AS2 Adapter trigger connection receives the data in native X12 HIPAA version 2 format from the trading partner, unpacks it, and delivers it for translation to XML format by the B2B action in an integration.
  • The XML is sent to the backend integration for further processing.
• Invoke (outbound) direction:
  • The XML data is translated in the backend integration to native X12 HIPAA version 2 format.
  • The AS2 Adapter invoke connection packs the received X12 HIPAA format and sends it to the target trading partner.

B2B for Oracle Integration supports the following X12 HIPAA version 2.0 standards:

• 005010X212 Health Care Claim Status Request and Response
• 005010X214 Health Care Claim Acknowledgment
• 005010X217 Health Care Services Review - Request for Review and Response
• 005010X218 Payroll Deducted and Other Group Premium Payment For Insurance Products
• 005010X220 Benefit Enrollment and Maintenance
• 005010X221 Health Care Claim Payment Advice
• 005010X222 Health Care Claim Professional
• 005010X223 Health Care Claim Institutional
• 005010X224 Health Care Claim Dental
• 005010X231 Implementation Acknowledgment for Health Care Insurance
• 005010X279 Health Care Eligibility Benefit Inquiry and Response