White Papers & Issue Briefs

Knowledge Center Best Practices for Reducing Unnecessary Duplicate Claim Submissions September 9, 2020 The industry suffers from a high rate of rejections and/or denials caused by duplicate claim submissions to the payer. Handling duplicate claims consumes valuable staff time and incurs cost and burden to those stakeholders impacted: providers, software vendors, payers, and clearinghouses. Therefore,…

Knowledge Center Payment Models Workgroup — Did You Know? September 1, 2020 This issue brief is the first in an ongoing series of briefs intended to provide education and clarification related to payment models and related technologies, terminology and trends. Payment Models Workgroup — Did You Know? Back to Knowledge Center Categories Articles Comment Letters Podcasts…

Knowledge Center Incorrectly Routed Payments And Remittance Advice July 29, 2020 This paper provides education and guidance to payers and providers on situations that occur when electronic healthcare claim payments and/or remittance advice are routed to a receiver incorrectly; for example, using the provider’s Taxpayer Identifier Number (TIN), but the payment is meant for a…

Knowledge Center Overcoming Barriers to the Broader Adoption of Telehealth April 9, 2020 Note: This paper was written during 2019 and early 2020 and is a summary of WEDI’s fall 2018 Barriers to the Broader Adoption of Telehealth survey and the industry’s on telehealth adoption between fall 2018 and January 2020. The paper does not…

Knowledge Center Provider Adjustments (PLB) in the Electronic Remittance Advice (835) March 12, 2020 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.…

Knowledge Center ERA/EFT Reconciliation in Dentistry February 14, 2020 In dentistry, adoption of the 835 and EFT remains markedly low in comparison to other sectors of the health care industry. This Issue Brief is intended to educate, and to assist, industry stakeholders regarding efforts to solve these problems. ERA/EFT Reconciliation in Dentistry Back to Knowledge…

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…

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.

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.

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…