EDI Enrollments EDI is an abbreviation for Electronic Data Interchange, an innovative electronic communication technology. It is a structured way to transmit data between computer systems using established message formats and standards.  When utilizing healthcare EDI transactions healthcare pro...

Medicare credentialing  All the providers must be credentialed with Medicare before start billing for their services. Group practices and the providers within the group must be separately credentialed and linked together to start billing. All the enrollment applications must be submitted to the cor...

Provider credentialing Physician credentialing is the process by which insurance networks, healthcare organizations, and hospitals obtain and evaluate documentation regarding a medical provider’s education, training, work history, licensure, regulatory compliance record, and malpractice histor...

EOB (Explanation Of Benefits) After a claim processes in medical billing, payment follows. Each payment is accompanied by an explanation of benefits, or EOB. The EOB is sent to the patient and the provider to show how the claim processed. It also lets the provider know whether any remaining balance ...

Superbill A superbill is an itemized form, used by healthcare providers in the United States, which details the services provided to a patient. It is the main data source for creation of a healthcare claim, which will be submitted to payers (insurances) for reimbursement. There is no standard format...

Diagnosis Diagnosis describe any diseases, illnesses or injuries a patient may have. It can be represented in a claim as ICD 10  code. ICD-10 codes are alphanumeric codes used by doctors, health insurance companies, and public health agencies across the world to represent diagnoses. Every disea...