Medical Billing

I strongly feel that the Development of PMS Product is more on the domain/business logic other than the technology. So would like to share the information in PMS through my blog. There are lot of articles/books/documents sitting on my desk which I have collected from various sources for the past 10 years. From that, so I will try to educate on that in a simple and easy to understand way with an example when necessary.

1. What is an EDI?
2. EDI Transactions
3. Understanding EDI Structure (Beginner)
4. Understanding EDI Structure (Detail )
5. EDI Instruction
6. Difference Between 837 Institutional and 837 Professional
7. EDI 5010 Documentation 837 Health care claim: Professional
8. EDI 270 - 5010 Health Care Eligibility/Benefit Inquiry
9. Claim Forward to other Insurance

Chapter 4: Payment
1. EOB – Explanation of Benefits
Understanding EOB - Explanation of Benefits
3. Understanding EDI 835 Electronic Remittance Advice
4. What is Copay, Co-Insurance, and Deductible in Insurance Payment Posting?

5. Types of Reimbursement
6. How to process Copay, Co-Insurance, and Deductible Amount in Insurance Payment Posting?

Chapter 5: Claim Submission after Primary Insurance
1. How to submit the claims after primary insurance?

Chapter 7: Claim Processing by the insurance company
1. Claims adjudication and Payment process.?


New to Health care Domain? Here are some documents which can help you to understand the basics. I am trying to refer to the official link(where I downloaded the document) and as well as a link to my server(sometimes, official links are broken).

1. Introduction_to_Health_Care_in_USA (or you can click here to download)
Medicare Incentive Program Beginners guide MU Stage 1 ( or you can click here to download)

All about Prescription

Flow charts

Medical Billing blogs