Operational Metrics That Actually Matter in Healthcare EDI In healthcare EDI, dashboards are often full, but insight is scarce. Many organizations still track activity instead of outcomes: file counts, messages sent, or transactions processed. Those numbers look comforting, yet they say very little about whether EDI is actually doing its job. If EDI is critical … Read More →
Trading Partner Agreements in Healthcare: The Hidden Source of EDI Non-Compliance When healthcare EDI breaks, teams often blame mappings, code sets, or “payer quirks.” In practice, many compliance issues originate somewhere less technical and more overlooked: the Trading Partner Agreement (TPA). TPAs sit in an uncomfortable middle ground. They’re not standards documents like X12 implementation … Read More →
HIPAA Enforcement in Practice: What Auditors Actually Look for in X12 Transactions HIPAA enforcement is often discussed in abstract terms — policies, safeguards, and “reasonable controls.” When auditors review X12 transactions, they are not judging intentions or architecture diagrams. They look for evidence — clear, traceable, repeatable evidence. Here’s what actually gets examined in real-world … Read More →
Understanding 835 Remittance Advice: Reconciling Provider Payments In healthcare revenue cycle management, getting paid is only half the story. The other half is understanding why you were paid what you were paid. This is where the EDI 835 transaction, also known as the Electronic Remittance Advice (ERA), earns its keep. The 835 explains how … Read More →