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White Papers & Issue Briefs

Claim Reporting for Appropriate Use Criteria for Advanced Diagnostic Imaging

Knowledge Center Claim Reporting for Appropriate Use Criteria for Advanced Diagnostic Imaging November 14, 2019 The purpose of this issue brief is to provide information regarding the Center for Medicare & Medicaid Services’ (CMS) Appropriate Use Criteria (AUC) for Advanced Diagnostic Imaging program. The program requires actions to be taken by both ordering and rendering…

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Updated Telehealth Resource Guide

Table 1 provides a list of telehealth resources that the Telehealth Workgroup identified as being useful and informative for the industry. This list is not all inclusive. The Telehealth Workgroup plans to review and update this list semiannually. Please contact the Telehealth Workgroup co-chairs to have additional resources considered for inclusion in the guide.

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Understanding the Models and Definitions of Encounters

The purpose of this white paper is to provide a baseline understanding of the models and definitions of health care encounters. Following an overview of encounters, it will explore various models and how data are exchanged between health care plans, payers, providers, and other entities, as well as define commonly used terms related to encounters. This paper will establish a foundation for future work on more detailed reviews of encounter models and identification of data needs.

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Did You Know?

Knowledge Center Did You Know? July 22, 2019 Welcome to “Did You Know?”! In our recent acknowledgement survey, we identified a need to provide an issue brief providing education on some basic misunderstandings related to acknowledgements within HIPAA transaction exchange using the ASC X12 Version 005010 (5010). We are providing this education using a brief…

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Provider Adjustments (PLB) in the Electronic Remittance Advice (835)

Knowledge Center Provider Adjustments (PLB) in the Electronic Remittance Advice (835) May 20, 2019 The purpose of this paper is to provide guidance and information on the functionality and usage of the Provider Adjustment Segment (PLB) within the electronic remittance advice (ASC X12N 835 transaction) for specific business use cases, as described in the appendices.…

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The WEDI Prior Authorization Council

Knowledge Center The WEDI Prior Authorization Council February 5, 2019 The observations, findings and recommendations that follow represent the output of the Council’s three phases of activity. The WEDI Prior Authorization Council Back to Knowledge Center Categories Articles Comment Letters Press Releases Uncategorized White Papers & Issue Briefs Recent Posts WEDI: Tech limitations, lack of…

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EFT Enrollment Security

Knowledge Center EFT Enrollment Security October 5, 2018 The secure implementation of Electronic Funds Transfer (EFT) Enrollment for payment of health care claims has presented some challenges for health care entities. The purpose of this paper is to recommend best practices to protect the security of all entities involved in Electronic Funds Transfer Enrollment. EFT…

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Making Precision Medicine the Standard of Care Part 1 – Clinical & Business Drivers

Knowledge Center Making Precision Medicine the Standard of Care Part 1 – Clinical & Business Drivers October 4, 2018 Leading health care systems, clinical laboratories, vendors and health plans are all increasing their focus on providing precision medicine (PM) through the use of genetic and genomic information. Venture capital funding has increased exponentially in this…

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Dental Claims

Knowledge Center Dental Claims June 13, 2018 The purpose of this white paper is to provide guidance on how to populate the ASC X12N 005010X224A2 Health Care Claim: Dental (837D) electronic transaction from the data reported on the ADA Dental Claim Form (© 2012 American Dental Association). The ASC X12N 005010X224A2 Health Care Claim: Dental…

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Telehealth Modalities

Knowledge Center Telehealth Modalities March 13, 2018 The purpose of this white paper is to provide information on the various modes of delivering patient care using telehealth services and technology, including virtual encounters, remote patient monitoring, wearable devices, and integrated care management. Telehealth Modalities Back to Knowledge Center Categories Articles Comment Letters Press Releases Uncategorized…

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