Implementing Safeguards for HIPAA Compliance: A Three-Pronged Approach Achieving HIPAA compliance is not just about understanding the rules – it’s about putting them into action. One of the most critical requirements of the HIPAA Security Rule is the implementation of safeguards that protect electronic Protected Health Information (ePHI) from unauthorized access, use, or disclosure. These … Read More →
Claim rejections and denials: similar, but different Claim rejections and denials sound deceptively similar, which is probably why many healthcare teams treat them as interchangeable. Yet in the EDI world, these two outcomes sit on opposite sides of a crucial workflow fork. One stops the claim before it ever enters the payer’s system; the other … Read More →
CMS HETS EDI Enrollment Update: 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 HETS to submit 270 eligibility requests and receive 271 eligibility responses for Medicare beneficiary information. That is why the CMS HETS … Read More →
CMS issued a 2026 update related to CAQH CORE 360 CARC, RARC, and CAGC combinations for 835 Electronic Remittance Advice workflows Healthcare EDI compliance is not only about sending and receiving files. It is also about using the information inside those files correctly. That is especially true for the X12 835 Electronic Remittance Advice. The 835 … Read More →