Understanding HIPAA and the Importance of Securing Patient Health Information in Transactions The Health Insurance Portability and Accountability Act (HIPAA), enacted in 1996, is a foundational U.S. law that governs the privacy and security of protected health information (PHI). Its main goal is to ensure that individuals’ medical records and other personal health data are … Read More →
Turn Paper EOBs into 835 ERAs: Cut the Manual Workload While most healthcare payments today are processed electronically, some payers still send paper Explanations of Benefits (EOBs). These documents contain the same data as their digital counterparts sent via EDI – the 835 Electronic Remittance Advice (ERA). Even if paper EOBs make up just a … Read More →
How to Map a Medicare 271 to a CWF: A Quick Guide for Healthcare Data Teams When working with Medicare eligibility data, one common task is mapping a 271 Eligibility Response to Common Working File (CWF) data structures. While both formats serve to describe a patient’s eligibility, they follow different standards – 271 follows the … Read More →
Understanding the Most Common Eligibility Errors in Healthcare EDI In healthcare, accurate eligibility verification is critical for ensuring timely claims processing and avoiding costly rework. Electronic Data Interchange (EDI) transactions, particularly the 270 (Eligibility Inquiry) and 271 (Eligibility Response), are key tools for checking a patient’s insurance coverage. However, even with automation, eligibility errors are … Read More →