Real-Time Adjudication (RTA) – a critical component of healthcare Electronic Data Interchange (EDI) Real-Time Adjudication plays a crucial role in expediting claims processing, leading to faster reimbursement and improved cash flow for healthcare providers. Let’s explore the use of RTA in healthcare EDI in more detail. 1. Real-Time Claims Processing One of the primary benefits of … Read More →
Recommendations for implementation of the GS1 rules and standards in healthcare industry. Step-by-step guide Before engaging in any implementation of GS1 standards in healthcare, GS1 MOs and healthcare industry stakeholders should consider what opportunities exist for their organisation to better serve existing users or trading partners as well as how to expand the use of GS1 standards in this sector. … Read More →
EDI implementation drivers in healthcare: GS1 Guides Drivers for the implementation of EDI in healthcare may vary between markets as a result of internal and external factors. However, they generally fall into the following categories according to GS1 guidelines: Helping to ensure quality of care Meeting regulatory or trading partner requirements Facilitating product traceability Increasing supply chain efficiency and … Read More →
The CGS Medicare list of the TOP 10 EDI Claim Edits during claims submission Most claims that hit the CGS ACE pre-adjudication editing process are not forwarded to the claims processing system. If a claim receives a Smart Edit, review the information, decide if updates are needed or not, and resubmit it for processing. To … Read More →