Post-Adjudicated Claims Data Reporting: Enhancing Healthcare Insights Through EDI Post-adjudicated Claims Data Reporting serves as a vital process that enables health plans and public health entities to analyze, audit, and improve healthcare delivery based on already-processed claims. Unlike claims in progress, post-adjudicated data refers to claims that have gone through the full adjudication cycle—meaning they’ve … Read More →
Understanding HIPAA Application Advice (X186A1): A Guide with Examples The HIPAA Application Advice (X186A1) transaction plays a critical role in ensuring transparency and efficiency in claim processing and other EDI submissions. This transaction, also known as the Transaction Acknowledgment, provides detailed feedback when a HIPAA-compliant transaction fails to meet certain application-level requirements – even if … Read More →
How to Optimize Monthly Eligibility Refresh Checks in Healthcare Eligibility verification is not a one-time event — especially for long-term care, recurring treatments, or chronic condition management. That’s where monthly eligibility refresh checks come into play. These checks help ensure that patient insurance coverage is still valid and hasn’t changed, reducing the risk of denials … Read More →
Sending Healthcare Claim Attachments via EDI: A Technical Guide with Examples In healthcare EDI, claim attachments play a vital role in providing additional documentation that supports the adjudication of claims. Whether you’re dealing with X-rays, lab reports, or itemized bills, transmitting these documents electronically through the ASC X12N 275 transaction set helps reduce delays, … Read More →