White Paper

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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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 Issue Brief Press Releases Uncategorized White Paper Recent Posts WEDI Announces Additional Details for Winter…

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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 Issue Brief Press…

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Barriers to Adoption of the ERA and EFT Transactions

Knowledge Center Barriers to Adoption of the ERA and EFT Transactions September 5, 2017 The purpose of this paper is to identify barriers to implementation of the HIPAA standard Health Care Electronic Funds Transfer (EFT) and Remittance Advice (ASC X12N Health Care Claim Payment/Advice (835) and the NACHA Corporate Credit or Debit Entry Plus Addenda…

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Electronic Payments: Guiding Principles

Knowledge Center Electronic Payments: Guiding Principles August 23, 2016 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, ACH EFT is significantly underutilized by the industry, with the most…

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Maximizing the Potential of Genomic Information to Improve Care Coordination and Health Outcomes

Knowledge Center Maximizing the Potential of Genomic Information to Improve Care Coordination and Health Outcomes August 23, 2016 Genomic medicine offers the potential to greatly improve medical practice by tailoring the preventive, diagnostic and therapeutic care available to each patient. However, this potential depends on high-quality data that can be readily accessed and applied in…

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