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 →
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 →