837 Claim Acceptance vs. Payment Reality: Why “Accepted” Claim Doesn’t Mean “Payable” In healthcare EDI, one of the most common misunderstandings is the assumption that an accepted 837 claim is on track for payment. It is not. An accepted claim only means the file passed a certain stage of review. It does not confirm that … Read More →
Medicare vs. Commercial Payers: Structural and Behavioral Differences in EDI In healthcare EDI, the standards may be the same, but payer behavior is not. Both Medicare and commercial payers use HIPAA-standard transactions. On paper, that creates a sense of consistency. In practice, however, providers, billers, and EDI teams often experience these payer environments very differently. The … Read More →
CMS Finalizes Electronic Claims Attachments Standards: A Major EDI Step for U.S. Healthcare A major EDI development has arrived in U.S. healthcare. On March 20, 2026, the Centers for Medicare & Medicaid Services (CMS) finalized the first HIPAA-adopted standards for electronic health care claims attachments and electronic signatures. This is a meaningful step toward replacing … 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 →