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 →
EDI Testing in Healthcare: Why Certification Is Not Enough In healthcare EDI, certification matters. But it is not the finish line. Many teams treat payer certification or initial transaction approval as proof that an interface is fully complete. In reality, certification only shows that a transaction passed under specific conditions at a specific moment in time. … Read More →
HIPAA Administrative Simplification in 2026: What EDI Teams Should Watch Now If you were expecting a brand-new wave of HIPAA transaction operating-rule deadlines in 2026, the plot twist is: not yet. As of March 12, 2026, the federally mandated HIPAA operating-rule compliance dates for core administrative transactions remain the same. CMS still lists January 1, … Read More →