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 →
HIPAA Administrative Simplification in 2026: What EDI Teams Should Watch Now If you were expecting a brand-new wave of HIPAA transaction operating-rule deadlines in 2026, the plot twist is: not yet. As of March 12, 2026, the federally mandated HIPAA operating-rule compliance dates for core administrative transactions remain the same. CMS still lists January 1, … Read More →
How Companion Guides Work with ASC X12 TR3s in Real Medicare EDI In Medicare EDI, the ASC X12 TR3 implementation guide is the main rulebook. It explains the standard format of a transaction, including what data elements can be used, where they go, and which ones are required. But in real life, the TR3 … Read More →