WEDI Papers & Fact Sheets

Knowledge Center EFT and ERA Enrollment Process White Paper February 2, 2024 The enrollment process for EFT and ERA varies widely throughout the industry today.  This document was previously published in 2013 and has been updated to include an overview of enrollment processes for ERA and EFT, along with best practices and model enrollment forms.…

Knowledge Center WEDI Prior Authorization Electronic Inquiry: Guiding Principles October 16, 2023 The purpose of this document is to offer guidance across stakeholder groups to support the increased utilization and maximal efficiency of electronic prior authorization (PA) inquiry transactions. Download Paper Back to Knowledge Center Categories Comments & Letters Podcasts Press Releases Regulatory Updates SDOs…

Knowledge Center Reporting Tiered Benefits June 5, 2023 Tiered benefits can have different meanings or be defined differently by payers and providers. They may interpret the data they exchange differently, as well as how that information could be applied when delivering patient care. Both traditional and more complex benefit plan designs have been introduced into…

Knowledge Center No Surprises Act – Good Faith Estimate Use Cases May 5, 2023 Claims Subworkgroup & No Surprises Act Task Group These use cases describe common scenarios for which the Good Faith Estimate would be used. The purpose is to illustrate the business workflow steps required to obtain the necessary information to populate and…

Knowledge Center Fact Sheet: Medicare Telehealth Changes After the PHE April 24, 2023 Since the public health emergency (PHE) related to the COVID-19 pandemic began in 2020, the Centers for Medicare & Medicaid Services (CMS) issued a series of waivers and flexibilities for telehealth services for Medicare beneficiaries. Some of these waivers and flexibilities were…

Knowledge Center Health Equity Terminology Level Setting March 15, 2023 To focus this work so we are all “rowing in the same direction,” we need to have a mutual understanding of the terms and their definitions that make up the language of health equity. Download the Paper Back to Knowledge Center Categories Comments & Letters…

Knowledge Center Electronic Payments: Guiding Principles December 16, 2022 The opportunities for improved efficiency and cost-savings associated with industry adoption of the Automated Clearing House (ACH) Electronic Funds Transfer (EFT) transaction are well established. However, despite having a national standard and supporting operating rules, compared to some other transactions ACH EFT is underutilized by the…

Knowledge Center Best Practices for Health Plans that Sub-Contract Creation of the Remittance Advice September 29, 2022 Providers are experiencing challenges in situations where they have a relationship/contract with a specific health plan (and submit their claims to that health plan), but that health plan then sub- contracts some or all services to a business…