News Update

Atlanta GA, July 15, 2020:

BNETAL has successfully completed a pilot of the Healthcare Prior Authorization (X12 278) transaction using BNETAL solutions, in collaboration with a healthcare industry partner. Prior Authorization is the transaction between a healthcare provider and a health plan to authorize a treatment or a service requested by a patient. Traditionally, this has been a very manual (fax, manual data inputs, manual reviews/approvals) process, making it very lengthy, cumbersome and costly. This pilot shows how BNETAL solutions can provide end-to-end automation and substantially bring down the processing time and hence the cost of Prior Authorization.

Within this pilot, BNETAL solutions SureDeliver® and SureEDI® are integrated with a practice management system to achieve the following:

  • Prior authorization in Real-time mode in conformance with CAQH CORE Phase IV Rules
  • Prior authorization in Batch mode in conformance with CAQH CORE Phase IV Rules
  • Integration with clinical systems (EMR/EHR) using clinical transport standards like NwHIN XDR, DIRECT
  • End-to-end tracking of batch transactions using an intuitive dashboard
  • rich set of status and error messages that are human readable so that corrective actions can be taken by non-technical staff when mistakes occur in the initial submission
  • Depending on client requirements, this pilot solution can be used as-is or customized, including integrating with other systems.
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BNETAL SureDeliver® is robust, secure, and ACA Section 1104 compliant gateway, which has been successfully implemented for regulatory compliance, operational efficiency and strong security. SureDeliver also provides turn-key solution for CORE Phase IV which has not yet been mandated, but is the rule governing the transport for prior authorization transactions. Within this pilot, SureDeliver® is used to provide CORE Phase IV real-time and batch transport capability.

BNETAL SureEDI® is a robust EDI/X12, HL7 and XML processing engine with EDI mapping, validation, translation and business rule application capabilities. Within the pilot, SureEDI is used to translate the X12 transactions into business level objects for processing, and to return X12 responses. The built-in healthcare data model of SureEDI is used to enforce business rules associated with prior authorization. Extensive dynamic validation of EDI data fields is done to generate validation responses and errors.

BNETAL's nationally recognized experts in connectivity and security have worked on projects including CDC PHIN (where BNETAL provided secure data exchange solutions that are used nationwide for disease data surveillance over the Internet) can be leveraged by Payers, Providers, Clearinghouses, and Vendors to provide enterprise grade connectivity and security that is scalable, maintainable, and supported by top-notch connectivity and security experts in the industry.

For more information on SureEDI® please email, or call 770-399-0433 or 315-391-0716.