270/271 Eligibility Verification: Best Practices for Fewer Denials and Faster Answers Before a claim ever gets submitted, there’s a question that determines a lot of what happens next: is this patient actually covered? The 270/271 transaction pair is how that question gets answered electronically — the 270 is the eligibility inquiry a provider sends, and … Read More →
837 Claims: Common Rejection Causes and the Acknowledgment Cycle Every EDI Team Should Track The 837 is the workhorse of healthcare EDI — the HIPAA-mandated transaction that carries claim data from providers to payers. But “837” isn’t one document. It’s a family of three: 837P (Professional, for physicians and outpatient providers) 837I (Institutional, for hospitals … Read More →
Healthcare EDI Best Practices: Staying HIPAA-Compliant While Keeping Transactions Moving Healthcare EDI operates under more regulatory weight than almost any other industry using electronic data interchange. Every 837 claim, 835 remittance, and 270/271 eligibility check carries electronic protected health information (ePHI), which means HIPAA compliance isn’t a separate workstream from EDI operations — it’s built … Read More →
TMHP’s VPN-to-SFTP Transition: A Reminder That Healthcare EDI Connectivity Isn’t Static The Texas Medicaid & Healthcare Partnership (TMHP) is updating its electronic submission process for EDI transactions effective August 1, 2026. Batch submitters who currently connect via VPN must migrate to a new SFTP-based connectivity method — VPN access is being turned off entirely on … Read More →