Eligibility Processing

XES Module for FHIR processes the following eligibility inquiries:

• Eligibility requests (EDI 270 transactions)
• Eligibility responses (EDI 271 transactions)

XES Module for FHIR uses the following two channels to work with medical data:

• EDI channel: Accepts EDI transactions. This channel is used when a provider submits an EDI eligibility inquiry but the insurer works on FHIR servers. This channel is also used for processing claims (converts HIPAA 837 transactions to the FHIR format).
• FHIR channel: Monitors new FHIR resources added to the insurer’s FHIR server. This channel is used when a provider submits a FHIR eligibility inquiry, and an insurer works on the FHIR server but has an EDI back-end system.