CAQH CORE

  CAQH CORE Code Combinations v3.10.0: What 835 Remittance Teams Should Review For healthcare EDI and revenue cycle teams, the X12 835 Remittance Advice is more than a payment file. It tells providers what was paid, denied, adjusted, recouped, or transferred to patient responsibility. That means the codes inside the 835 must be interpreted accurately. Read More →

CMS Medicare

  CMS Updates HETS EDI Enrollment Process: What Healthcare EDI Teams Should Review Medicare eligibility verification is a daily workflow for many healthcare organizations. Providers, vendors, clearinghouses, billing teams, and revenue cycle teams rely on accurate 270/271 transactions to confirm beneficiary eligibility before or after services are provided. That is why CMS’s HETS EDI enrollment Read More →

Clearinghouses EDI

Clearinghouses in Healthcare EDI: What They Do and Why They Matter Many healthcare providers do not send electronic claims and other EDI transactions directly to every payer. Instead, they often work through a clearinghouse. A clearinghouse is an intermediary that helps receive, check, format, route, and track healthcare EDI transactions between providers, payers, and sometimes Read More →