CAQH CORE Code Combinations v3.10.0: What 835 Remittance Teams Should Review For healthcare EDI and revenue cycle teams, the X12 835 Remittance Advice is more than a payment file. It tells providers what was paid, denied, adjusted, recouped, or transferred to patient responsibility. That means the codes inside the 835 must be interpreted accurately. … Read More →
CMS Updates HETS EDI Enrollment Process: 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 accurate 270/271 transactions to confirm beneficiary eligibility before or after services are provided. That is why CMS’s HETS EDI enrollment … Read More →
Clearinghouses in Healthcare EDI: What They Do and Why They Matter Many healthcare providers do not send electronic claims and other EDI transactions directly to every payer. Instead, they often work through a clearinghouse. A clearinghouse is an intermediary that helps receive, check, format, route, and track healthcare EDI transactions between providers, payers, and sometimes … Read More →
Preparing Healthcare EDI for Regulatory Change Without Breaking Production Healthcare EDI teams operate in an environment where change is constant. New rules, updated code sets, revised companion guides, enforcement timelines, payer requirements, and system upgrades can all affect production workflows. The challenge is not only understanding what changed. The bigger challenge is making the … Read More →