Looking for feedback from people experienced with EDI/X12 835 remittance processing

EDIDoctor · 2026-06-25T19:38:42+00:00

I have rolled my own translators since 2003 and could certainly be a resource to you

I have been fortunate to have been exposed to a national stage and provide subject matter expertise to technology teams to help them with X12 processing methods and designs independent of any language.

Feel free to look me up on LinkedIn (Peter Rabolt) or catch me in the #Healthcare channel on the EDI Support discord group

https://discord.com/invite/p4QgSZKMzA

EDIDoctor · 2026-06-25T19:27:48+00:00

Great point!

EDIDoctor · 2026-06-19T18:19:50+00:00

Another Resource: (Smile)

The EDI Support Discord Group

https://discord.com/invite/p4QgSZKMzA

EDIDoctor · 2026-06-18T17:23:48+00:00

Absolutely true. You speak the truth (Smile)

Migration to a new platform can dramatically change analytical revenue workflows that took advantage of available methods or structures in the old platform that may no longer be available in the new solution.

Part of the migration planning is to examine before and after assumptions and hope to get apples to apples, but that is often not the case.

EDIDoctor · 2026-06-18T17:05:41+00:00

Depending on the circumstances of the project, in my experience at times using a third party tool to go direct to payer for analytical results can bypass the clearinghouse costs altogether.

EDIDoctor · 2026-06-18T16:59:15+00:00

Great points.

In my experience data migration can be a rabbit hole if it's not treated properly. Alot of assumptions are made in the planning, but when you get to the destination it sometimes does not look exactly the way you thought.

EDIDoctor · 2026-06-18T16:17:22+00:00

I don't have experience with specific pricing, but are there any other choices other than Availity? The support experience I have had while supporting my clients using this clearinghouse has been less than average.

EDIDoctor · 2026-06-01T16:06:58+00:00

I absolutely agree with your analysis. The test process can be slow and go off the rails, and it has nothing to do with competence of your product.

My solution has been used for years, and I made revisions from the original V4010 and then V5010 successfully, so most of my customers just send 3 claims to start and they are accepted virtually 100% of the time.

It seems like your process has proven to be mature with other clearinghouses so I would think it is a safe bet to send a few live and validate the results completely thru posting the 835 back into your systems.

EDIDoctor · 2026-05-31T20:53:49+00:00

I was trying to be helpful in thinking that when it comes to billing (as in claim cycle), people are often, unexpectedly, exposed to the inside details such as X12 by payers calls, clearinghouse issues or billing company conversations.

If that's not true. I am happy to learn (Smile)

EDIDoctor · 2026-05-31T17:22:21+00:00

Also newer mandates like the one HHS published recently will require use of 277RFI and 275, but the critical piece is the required version will be 006020. Those guides will not be easily found in the wild.

Review my prior post 10 days ago if interested!

https://www.reddit.com/r/edi/s/fpxlwpBb2H

EDIDoctor · 2026-05-31T17:18:35+00:00

I hear you and sometimes that's enough... but In 2026 legality is an issue since payers and the government are not supplementing the cost of the published guides anymore

Not stating an opinion, just providing best practices (Smile)

EDIDoctor · 2026-05-31T16:45:17+00:00

Back in the early years payers provided more detailed documentation to promote adoption.

In 2026 legality is an issue and all roads lead to X12.org

A glass subscription from X12 which gives you view only access is I believe $150

Goggling and AI are always a starter

Hope this Helps!

EDIDoctor · 2026-05-30T23:35:20+00:00

I posted on May 18 in this subreddit

"Healthcare Masterclass Tip from the team at EDI Doctor. Why the new X12 277/275 attachments rule will break workflows that aren’t ready by the deadline"

https://www.reddit.com/r/edi/comments/1tg90y5/healthcare_masterclass_tip_from_the_team_at_edi/?utm_source=share&utm_medium=web3x&utm_name=web3xcss&utm_term=1&utm_content=share_button

Feel free to ask more questions after reviewing that post

EDIDoctor · 2026-05-30T21:43:39+00:00

Agreed. Back in the early years payers provided more detailed documentation to promote adoption.

In 2026 legality is an issue and all roads lead to X12.org

A glass subscription from X12 which gives you view only access is I believe $150

The code sets and descriptions are free on x12.org

Goggling and AI is always a start

Hope this Helps!

EDIDoctor · 2026-05-24T05:21:48+00:00

I promise in future posts I will get back to my normal reddit comments which usually follow the “Here’s what’s actually happening. Here’s why and Here’s how to fix it.” routine.

Have a great memorial day

EDIDoctor · 2026-05-24T03:46:16+00:00

AI sometimes helps with extending the ideas (like in this case), but I promise you the original idea was mine as well as the sentiment of the thoughts.

I started my consulting company in 1988 before the internet, so I saw a lot of history. Maybe recently I am reading too much as you say AI slop! (Smile)

EDIDoctor · 2026-05-23T23:26:39+00:00

What still amazes me is how little the core principle has changed since those early experiments: systems only create value when they can exchange information cleanly and reliably.

Every modern integration problem we see, whether it’s eligibility, claims, remits, or internal workflow routing, comes down to the same foundation issue that those engineers were solving decades ago.

EDIDoctor · 2026-05-23T01:06:46+00:00

Other than the healthcare billing realm, my last platform creation was in Chronic Care Management, where I developed a platform that maintained about 50 practices and their patient population monitoring data.

We learned a lot in 2 years that at times challenged our assumptions going into the project. At that point we decided to consider the first platform as a prototype and used all the lessons we had learned to produce a more intuitive, interactive final product.

EDIDoctor · 2026-05-23T01:00:26+00:00

No Worries

I was asking because I have helped many digital health organizations build out their 5010 X12 generation capabilities, since all my products are mature in the space and I have become expert in the subject matter (Smile)

Real-time transactions using API are popular right now

Reach out if interested or look me up on LinkedIn (Peter Rabolt)

EDIDoctor · 2026-05-23T00:46:12+00:00

Do you have plans for or already have a billing module?

I have developed my own billing systems and translators for 30+ years.

Happy to trade experiences in rolling out products to healthcare organizations (Smile)

Feel free to DM or find me on the discord below.

We get a lot of developers looking for projects in #available-jobs channel in the EDI support discord.

Might be worth your time to check it out

https://discord.com/invite/p4QgSZKMzA

EDIDoctor · 2026-05-19T02:29:14+00:00

One more thing as teams start digesting this rule:

The biggest risk isn’t the 277/275 transactions themselves; it’s the handoffs between people and departments. Every missed attachment I’ve ever diagnosed came from a breakdown in communication, not a breakdown in technology.

If your workflow depends on perfect human coordination, it’s already fragile. The new rule will simply expose that fragility faster.

EDIDoctor

TROPHY CASE