Understanding CMS Eligibility Checks: Why They Matter and How to Use Them Effectively Eligibility verification is the foundation of smooth claims processing and timely reimbursement. One of the most essential tools for this is the CMS eligibility check — a process that confirms whether a patient is eligible for Medicare benefits under the Centers for … Read More →
When and How to Send Claim Attachments in Healthcare EDI Submitting a healthcare claim is a standard part of requesting reimbursement from an insurance company or payer. Whether you’re submitting a professional (837P), dental (837D), or institutional (837I) claim, the goal is simple: get paid for the care you’ve delivered. But sometimes, the claim alone … Read More →
Real-World EDI Examples in Healthcare For developers, system architects, and IT leaders in the healthcare space, understanding EDI standards and optimizing their use continues to be essential for maintaining effective and scalable systems. Let’s take a closer look at how EDI actually looks “under the hood.” These examples represent typical data flows between healthcare providers and … Read More →
EDI in Healthcare: The ability to quickly and securely exchange data EDI has become the backbone of data transactions between providers and payers, enabling the exchange of crucial information like claims, reimbursements, eligibility confirmations, and benefits enrollment. Healthcare providers and insurance payers rely heavily on EDI to automate and standardize essential workflows. Common EDI transactions include: … Read More →