Clearinghouses in Healthcare EDI: What They Do and Why They Matter Many healthcare providers do not send electronic claims and other EDI transactions directly to every payer. Instead, they often work through a clearinghouse. A clearinghouse is an intermediary that helps receive, check, format, route, and track healthcare EDI transactions between providers, payers, and sometimes … Read More →
Preparing Healthcare EDI for Regulatory Change Without Breaking Production Healthcare EDI teams operate in an environment where change is constant. New rules, updated code sets, revised companion guides, enforcement timelines, payer requirements, and system upgrades can all affect production workflows. The challenge is not only understanding what changed. The bigger challenge is making the … Read More →
Healthcare Claims Attachments: Why X12 275 and 277 Matter Now Claims attachments have long been one of the most manual parts of healthcare administration. Even when claims are submitted electronically, supporting documentation may still move through fax, portals, mail, phone follow-ups, or payer-specific upload processes. That creates extra work for providers, payers, clearinghouses, and revenue … Read More →
835 Remittance Advice Reconciliation at Scale The 835 Electronic Remittance Advice is one of the most important transactions in healthcare EDI. It explains how a payer processed a claim, what was paid, what was denied, what was adjusted, and what remains as patient or secondary payer responsibility. For small claim volumes, teams may be able … Read More →