Handling Duplicate Benefits in 271 Eligibility Responses Duplicate benefits in 271 eligibility responses can be a frustrating challenge for providers, clearinghouses, and billing teams. What appears to be an error is often a reflection of payer logic, multiple benefit layers, or overlapping coverage types. Understanding the structure behind these duplicates and managing them effectively helps … Read More →
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 →