Edifecs XEngine

D A T A S H E E T

Unmatched performance to validate and process healthcare transactions

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Garbage in, garbage out exemplifies the peril that bad transaction data from partners represents to a healthcare organization. Allowing bad transaction data into core processes and systems increases processing errors and rework, degrades operational efficiency, increases support costs and impedes achieving compliance with regulatory mandates. Edifecs XEngine delivers unparalleled performance to validate transactions for syntax, semantics and custom business rules, thereby ensuring operational integrity of information exchange with trading partners. As shown in Figure 1, Edifecs XEngines enterprise-strength throughput capabilities enable fast and accurate validation of transactions at the edge-of-the-enterprise. By catching errors early, XEngine can separate good data from bad data thus allowing organizations to comply with legislative and company mandates. Good data can be further split into smaller logical units for efficient processing and routed to multiple downstream systems based on the contents of the transaction. XEngines translation capabilities allow data conversion between industry-standard formats and downstream system formats. XEngine can be purchased as a standalone product or as part of the Edifecs Healthcare Channel Modernization Product Suite.

Capabilities
With Edifecs XEngine, healthcare organizations can: Achieve high-speed, high-quality transaction performance by integrating data from all channels into a unified front-end system that uses a singlepass data processing approach to achieve highly scalable performance, while providing for clean error recovery and improved manageability. Validate inbound and outbound transactions against implementation and companion guidelines to weed out bad transactions at the edge of the enterprise; prevent failures in downstream processes. Translate data using sophisticated pattern recognition technology to automatically determine the format of incoming data and then, using maps that can be selected based on trading partner and/ or transaction type, directly translate into a target format. Split and route transaction data by breaking data into logical groups based on error status and then routing to the appropriate destination based on data content or user defined splitting rules. Customize front-end transaction processing by modifying data using rules specified in guidelines or by using the Translator module to implement more complex data translations.
Figure 1: Edifecs XEngine

Generate acknowledgements and reports by automatically converting error information into standard acknowledgements (TA1, 997, 999 etc), XML reports and human-readable HTML reports. Integrate with core systems across diverse IT environments using 15 included connectors for system integration (file, JMS, others), pre- and post-processing plug-ins to modify XEngine server processes, and by writing custom plug-in scripts to meet specific business requirements using an openstandard Groovy plug-in.

Edifecs XEngine

Benefits
As shown in Table 1, XEngine helps achieve compliance with regulatory mandates, improves transaction quality and operational efficiency, and reduces support and troubleshooting costs. Benefits Achieve Compliance with Regulatory and Industry Mandates Supporting Features
Utilize out-of-the-box support for WEDI SNIP Types 1-7. Exploit full support for both HIPAA 4010A1, 5010 and NCPDP D.0. Customize out-of-the-box rules to meet company mandates. Convert data between 4010A1 and 5010 to meet industry deadlines using 4010A1-5010 Map Library and XE Translator. Validate code values against 60+ clinical and non-clinical codesets that are updated monthly. Utilize full validation support for ICD-9 and ICD-10 diagnostic (CM) and procedure (PCS) codes. Leverage full compliance with NPI mandate to ensure proper format and check-digit. Meet state legislations for prompt pay laws by preventing bad transactions from causing fullfile rejections.

Improve Transaction Quality

Catch errors early using inline validation of inbound and outbound transactions to prevent failures in downstream systems. Intelligently filter good transactions from bad transactions to deliver high quality data to core processing systems. Improve first-pass rates of claims adjudication systems by moving pre-adjudication edits to the edge of the enterprise. Utilize out-of-the-box support for multiple healthcare industry standards without the need for add-on adapter purchases. Convert data from industry formats (4010A1, 5010, NCPDP, HL7) to core processing system formats (flat files, XML) using XE Translator. Reduce redundancies and costs by consolidating channels used to receive healthcare transactions into a single unified front-end system Separate inbound transactions into multiple core processing systems by data content (e.g., trading partner, transaction type, Payer ID). Streamline transaction flows and eliminate redundant steps through single-pass processing engine to validate, split, acknowledge, route and translate data. Automatically track all processed tasks using XE Servers inbuilt tracking system. Schedule tasks on a recurring basis or based on an event to reduce need for manual intervention or a need for external scheduling tools. Leverage the speed and accuracy of transaction processing to ensure claims are paid quickly and accurately. Provide error reports and automated acknowledgements (TA1, 997, 999, 824, 277U, 277CA) to submitter to help identify and resolve errors. Use in-built tracking system to help troubleshoot and resolve issues by quickly locating transactions and causes of an error. Automatically route bad data to work queues that are managed by Edifecs Exception Management module. Use email connector to alert users about problem data in near real-time, thereby eliminating the need for long-drawn manual troubleshooting. Generate error reports in intuitive, easy-to-read format to allow non-EDI users to identify location and cause of errors.

Streamline Operational Efficiency

Reduce Support & Troubleshooting Costs

Table 1: Benefits and Features of Edifecs XEngine

Edifecs XEngine

Modules
XEngine validates transactions from trading partners. It routes accurate data to core systems and identifies bad data for error processing. Edifecs XEngine is composed of ten modules that combine to allow configuration, execution and management of this process. Transaction Processor. Provides single pass data processing to validate, split, enrich, acknowledge and route in a single, uninterrupted process. This provides for clean error recovery and improved manageability of processing Translator. Enables direct translation from an incoming data format to a target data format using source and target formats defined in the MapBuilder Module of Edifecs SpecBuilder. HIPAA 4010A1-5010 Mapping Library. Provides pre-built maps that convert HIPAA 4010A1 data files to 5010, or HIPAA 5010 data files to 4010A1. Process Configurator. Configures XEngine task processing including transaction routes, processing priority, and system resource utilization. Job Manager. Launches processes, tasks or jobs based on scheduled time or based on system events. Connectors. Easily integrates XEngine into a wide range of healthcare transaction environments using 15 included connectors to integrate with systems such as WebSphere MQ, Microsoft MQ, TIBCO EMS and more. Pre-and Post-Process Plug-Ins. Provides process plug-ins to automate file processing before or after the message is validated, split, translated and routed. For example, file may need to be scrubbed because it contains extraneous data. Tracking System. Automatically tracks all processed tasks using an inbuilt tracking system. More extensive process tracking capabilities are provided by Edifecs Transaction Management. Configuration Manager. Provides a repository for creating and storing snapshots of XEngine Server configurations. Edifecs Application Management. Provides a single unified user interface for administrators to manage XEngine configuration and settings.

Edifecs HIPAA 5010 and Healthcare Channel Modernization Product Suite

The Edifecs Healthcare Product Suite includes three product lines Unified Testing, Unified Compliance and Unified Visibility. Together, these three product lines make up the Edifecs Unified Channel solution for modernization of the information processing (channels) infrastructure. The three product lines are composed of four products Ramp Management, SpecBuilder, XEngine and Transaction Management.

Edifecs Product Lines

Unified Testing provides a consistent, centralized, end-toend, collaborative and uniform way to on-board the entire trading partner community of providers, submitters and more. Edifecs Unified Testing includes guideline migration, test data generation, internal testing, external testing, 3rd party testing, connectivity testing and various others steps required in moving partners from initial engagement to ongoing production. Unified Testing consists of Edifecs SpecBuilder, Edifecs Ramp Management and Edifecs Compliance Online. Unified Compliance provides a channel-independent, centralized single front-end to ensure on-going compliance of production information exchanged with business partners and between business systems. Edifecs Unified Compliance supports all file formats and all standards including HIPAA 5010. Unified Compliance consists of Edifecs SpecBuilder (including MapBuilder) and Edifecs XEngine (including Translator). Unified Visibility allows full insight into all transaction activity across all information processing channels. With a unique business-normalized repository of all transaction information, Unified Visibility provides one centralized system for a full 360-degree view into a transaction lifecycle from initiation to fulfillment of that transaction. Unified Visibility enables a

single source of truth for transactional information for internal as well as external users. Unified Visibility includes Edifecs Transaction Management and Edifecs XEngine products.

Edifecs Products
Edifecs Ramp Management allows healthcare organizations to create a branded self-service portal for trading partners to perform end-to-end scenario-based testing of transactions. Edifecs SpecBuilder is a design-time tool that simplifies, reduces errors in and accelerates the design phase of healthcare information exchange. Edifecs XEngine delivers unparalleled performance to validate transactions for syntax, semantics and custom business rules, while enabling splitting, routing, aggregation, enrichment of transactions and translation between multiple standards. Edifecs Transaction Management provides a secure, endto-end view of the healthcare transaction lifecycle to internal users and trading partners.

About Edifecs
An industry leader since 1996, Edifecs provides healthcare software and solutions that automate exchange of information between health plans, hospitals, pharmacy benefit managers and other healthcare organizations. Edifecs healthcare offerings enable compliance with current mandates, improve governance through enhanced end-to-end visibility and enhance operational efficiency by reducing costs. Edifecs has over 350 healthcare customers (that include Blue Plans, Medicaid, State and Federal agencies, Healthcare Providers) and partners such as IBM, Oracle, TIBCO, Informatica and Axway. Edifecs has been recognized as one of the 100 Fastest Growing Private Companies in Washington state, 100 best places to work for in Washington state, and Inc5000 fastest growing private companies in the US. Edifecs CEO is a recognized business leader (40-Under-40). Edifecs is headquartered in Bellevue, WA. Company website: www.edifecs.com.