Preparing Healthcare EDI for Regulatory Change Without Breaking Production Healthcare EDI is built on standards, but that does not mean it is static. New rules, revised code sets, operating rule updates, companion guide changes, payer-specific edits, and enforcement timelines can all affect production workflows. For providers, payers, clearinghouses, and billing vendors, the challenge is not … Read More →
Steps for Enrolling Providers and Authorizing Clearinghouses/Billers in Medicare EDI In Medicare EDI, enrollment is not just a technical setup step. It is a formal authorization process that determines who may submit, receive, or access electronic Medicare transactions on behalf of a provider. This matters whether the provider exchanges data directly with Medicare or works … Read More →
PHI Security in EDI Pipelines: Beyond Encryption at Rest and in Transit The HIPAA Security Rule is broader than “encrypt the data.” It requires regulated entities to protect the confidentiality, integrity, and availability of ePHI through administrative, physical, and technical safeguards. Its technical safeguards specifically include access control, audit controls, integrity, person or entity … Read More →
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 →