How to Conduct a Risk Assessment for a Healthcare Organization to Protect Sensitive Information Conducting a risk assessment is a foundational step in protecting sensitive patient information and ensuring HIPAA compliance for any healthcare organization. A well-executed risk assessment helps identify vulnerabilities in systems, processes, and workflows that could expose Protected Health Information (PHI) to … Read More →
EDI Testing in Healthcare: Why Certification Is Not Enough In healthcare EDI, certification matters. But it is not the finish line. Many teams treat payer certification or initial transaction approval as proof that an interface is fully complete. In reality, certification only shows that a transaction passed under specific conditions at a specific moment in time. … Read More →
837 Claim Rejections: The Edge Cases Your Clearinghouse Won’t Catch Most clearinghouse edits catch the obvious stuff — missing NPI, malformed dates, invalid ISA/GS envelopes. That’s table stakes. The rejections that actually cost you time and revenue are the ones that pass clearinghouse validation cleanly and still bounce at the payer, because the clearinghouse is … Read More →
Steps for Enrolling Providers and Authorizing Clearinghouses/Billers in Medicare EDI In Medicare EDI, enrollment is not just a technical setup step. It is a formal authorization process that determines who may submit, receive, or access electronic Medicare transactions on behalf of a provider. This matters whether the provider exchanges data directly with Medicare or works … Read More →