Edifecs SpecBuilder
DATA SHEET
Establish, communicate and test transaction specifications
with trading partners
The reliable exchange of information with trading partners is foundational to the
operations of today’s healthcare enterprises. Poorly designed specifications,
incomplete transaction flow maps and insufficient testing produce transaction errors,
low first-pass rates and long processing cycles. The consequences aren’t limited to the
waste of time and resources. They undermine the trust that is essential to the
consistent exchange of information between trading partners.
Edifecs SpecBuilder is an integrated and easy-to-use tool that simplifies and
accelerates authoring, testing and publishing specifications and processing maps for
healthcare transaction processing. With a library of more than 30,000 prebuilt trade
specifications, SpecBuilder reduces costs and facilitates definition and management. At
the same time, it promotes the sharing of clear and accurate trade specifications as
well as transaction flow route maps. These specifications can be used by team
members, trading partners and directly by run-time processes. Healthcare organizations
and their trading partners benefit from reduced integration time, enhanced operational
efficiency and cost savings.
WHY EDIFECS SPECBUILDER?
▪▪ Reduces the time and cost of defining
trade specifications and process maps
▪▪ Leverages more than 30,000 prebuilt
templates, including HIPAA, X12, and
more
▪▪ Facilitates collaboration with trading
partners to define specifications
▪▪ Supports clinical transactions,
including CCD/CDA, HL7 v2, HL7 v3 and
more
▪▪ Tests for compliance using internal and
partner data files
Capabilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
USING SPECBUILDER’S INTEGRATED TOOLS BUSINESS AND IT USERS CAN:
▪▪ Develop guidelines rapidly with an intuitive editor and
library containing more than 30,000 prebuilt templates.
The hierarchical editor permits specification creation either from
scratch or existing formats, even from a data file. Custom
business rules can be added to ensure that the data format and
values meet business needs, including the handling of errors
▪▪ Share guidelines and related data and error information
with trading partners, external vendors or other entities.
Related artifacts, such as guidelines, maps and data files, can be
managed in a common project repository and published in
multiple formats including HTML, RTF and PDF
▪▪ Protect PHI (Personal Health Information) and comply with
HIPAA data privacy rules through sophisticated deidentification capabilities
to identify and resolve errors. Highlight differences in data files
before and after system changes
▪▪ Streamline management of multiple standards and
formats using maps by performing gap analysis between
different versions of guidelines, mapping between multiple
standards and formats, and migrating guidelines between
different versions of healthcare standards.
▪▪ Increase processing speed and accuracy by creating and
maintaining code correlation tables that support runtime
validation and transformation between standard and
proprietary files
▪▪ Store transaction information and generate outbound
transactions from databases using database adapters
▪▪ Troubleshoot errors rapidly by analyzing data files and
visually cross-linking between reports, guidelines and data files
www.edifecs.com
(continued)
Edifecs SpecBuilder
Benefits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
As shown in Table 1, SpecBuilder helps healthcare organizations reduce costs, meet HIPAA and other mandates, improve transaction quality,
streamline guideline rollout and trading partner integration and enhance operational efficiency.
BENEFITS
SUPPORTING FEATURES
Improve Transaction Quality
▪▪
▪▪
▪▪
▪▪
..............................
Define and test transactions in a desktop environment before deployment
Use predefined HIPAA, HL7, NCPDP and other guidelines to achieve compliance
Leverage monthly updated code sets to facilitate ongoing compliance
Create and maintain code correlation tables to support runtime validation and transformation between standard
and proprietary files containing codes
▪▪ Add custom business rules to guidelines to improve first pass rates
▪▪ Comply with companion guide publishing formats from CAQH CORE Operating Rules and DISA X12
..........................................................................................................................
▪▪ Utilize 30,000 templates including CCD with Schematron, X12N, Post Adjudication Formats, and other guidelines
▪▪ Build route maps using standard formats (X12, HIPAA, HL7), proprietary formats (positional, CSV, XML) or batch
files
▪▪ Reverse engineer specifications from data files (Flat file or XML) using SpecGenerator
▪▪ Reduce troubleshooting time with business and technical reports that categorize HIPAA errors by WEDI SNIP Type
▪▪ Share error information through HTML, RTF and XML error reports
▪▪ Share user notes and comments about specifications to facilitate knowledge exchange and consistency
▪▪ Quickly perform gap analysis and perform point-and-click migrations between different versions of guidelines,
such as 4010 and 5010
▪▪ Import and export specifications and data efficiently using a broad range of tools and third-party applications,
including XSD, COBOL, SAP Idoc and others
..........................................................................................................................
▪▪ Use hierarchical data editor to reduce need for separate tools to view, edit and search/replace data files in line
▪▪ Gain ad-hoc business insights directly from transaction data without the need for expensive ETL and data
warehouse tools
▪▪ Accelerate testing by generating “happy-path” and negative test data directly from guidelines
▪▪ Create test data from production data, and customize by specifying seed values in dictionaries
▪▪ Highlight differences in data files before and after system changes
▪▪ Manage code crosswalks using an intuitive UI and subsequently during runtime
▪▪ Migrate seamlessly between different versions of the standards
..........................................................................................................................
Improve Trading Partner
Relations
▪▪ Store and manage related artifacts such as guidelines, maps and data files in a common project repository where
commits, updates and deletes can be performed as a single action
and Achieve Compliance
..............................
Reduce Implementation Time
..............................
Reduce Administrative Costs
and Improve Efficiency
▪▪ Publish guidelines, maps and data files in various formats, such as MS Word, MS Excel, HTML, RTF and PDF, either as
individual files or as a package
▪▪ Deidentify data to protect PHI when sharing with partners
▪▪ Test partner data files against implementation guidelines and provide meaningful error analysis for quick problem
resolution
▪▪ Troubleshoot HIPAA code-value issues across 60+ external code sets with effective dates and end dates,
including ICD-9, ICD-10, drug codes, and ADA codes
▪▪ Relax compliance requirements for nonmaterial transactions to increase electronic intake
Table 1: Benefits and Features of Edifecs SpecBuilder
An industry leader since 1996, Edifecs provides global healthcare information technology that reduces
administrative cost, improves revenue sustainability, and increases collaboration and operational performance
among health organizations, insurers, pharmacy benefit management companies, and other trading partners.
Today, more than 250 healthcare customers use Edifecs technology to unify financial, clinical and administrative
transactions from multiple channels, while automating manual business processes such as enrollment, claims and
payments management. Edifecs’ solutions and services support international and domestic compliance for HIPAA,
Operating Rules and ICD-10. Edifecs’ supply chain management solutions also support over 50 general industry
customers. Edifecs is headquartered in Bellevue, WA with operations internationally. For more information, please
visit http://www.edifecs.com.
©2014. Edifecs Corporation. All rights Reserved. May, 2014