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 →
835 Remittance Advice Reconciliation at Scale The 835 Electronic Remittance Advice is one of the most important transactions in healthcare EDI. It explains how a payer processed a claim, what was paid, what was denied, what was adjusted, and what remains as patient or secondary payer responsibility. For small claim volumes, teams may be able … Read More →