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 →
Understanding CMS Eligibility Checks: Why They Matter and How to Use Them Effectively Eligibility verification is the foundation of smooth claims processing and timely reimbursement. One of the most essential tools for this is the CMS eligibility check — a process that confirms whether a patient is eligible for Medicare benefits under the Centers for … Read More →
When and How to Send Claim Attachments in Healthcare EDI Submitting a healthcare claim is a standard part of requesting reimbursement from an insurance company or payer. Whether you’re submitting a professional (837P), dental (837D), or institutional (837I) claim, the goal is simple: get paid for the care you’ve delivered. But sometimes, the claim alone … Read More →