Claims Processing

With XES Module for FHIR, you can convert HIPAA claims to the FHIR format. XES Module for FHIR uses the EDI channel to process EDI 837 transactions and uses segments of EDI claim transactions to create FHIR resources and does the following:

• Receives an EDI professional claim file, the version 5010A 837x222A1.
• Splits EDI 837 to individual claims.
• Converts EDI 837 data to a FHIR bundle using the mapping rules.
• Submits the FHIR bundle to the FHIR server.

To load a claim to XES Module for FHIR:

1. On the Claims page of the web portal, click Browse for Claim EDI.
2. Navigate to the 837 EDI file you want to load.
3. Click Load Claim. New claims are added to the List of Claims.