X12 and X12 HIPAA: related but still distinct concepts X12 refers to a set of standards developed by the Accredited Standards Committee (ASC) X12, which is responsible for developing and maintaining electronic data interchange (EDI) standards in the United States. These standards govern the exchange of business documents, such as purchase orders, invoices, and shipping Read More →

Medical Codes

Health Care Code Sets Types In healthcare electronic data interchange (HIPAA EDI), code sets play a fundamental role in standardizing the representation of various healthcare concepts, such as diagnoses, procedures, medications, and other medical entities. These code sets are used to facilitate the exchange of healthcare information between different healthcare providers, payers, and systems. Here are Read More →


CAQH CORE Operating Rules for Eligibility and Claims Status Operating rules for eligibility and claims status went into effect on January 1, 2013. They make it easier for providers to determine: Whether a patient is eligible for coverage (transaction 270/271) The status of a health care claim submitted to a health insurer (transaction 276/277) Eligibility Read More →

EDI HIPAA operations

Health Care Claims Subgroup Co-Chairs: Rule Development Update As representatives of healthcare business services companies, provider organizations, health plans, and associations, CAQH CORE spends time optimizing data transmission workflows to improve healthcare administration in our day-to-day jobs. Within the health care claims processing landscape, efficiency remains a key challenge. Per the 2022 CAQH Index, over 9 Read More →