USHealthcare 49
- Utilization Management Explained
- Prior Authorization: The Step-by-Step Workflow
- Medical Coding Basics: ICD-10-CM, CPT and HCPCS
- CPT vs HCPCS: Real Examples to Tell Them Apart
- Claim Repricing: How a $5,000 Bill Becomes $900
- In-Network vs Out-of-Network Providers
- Health Plan Types: HMO vs PPO vs EPO vs POS vs HDHP
- Patient Cost Sharing: Premium, Deductible, Copay, Coinsurance and Out-of-Pocket Max
- De-identifying PHI in X12 Files with Python (pyx12)
- Medicare vs Medicaid, and Dual-Eligible Members
- Medicare Explained: Parts A, B, C and D
- The 2027 Medicaid Changes Under the One Big Beautiful Bill Act
- Medicaid and CHIP Explained
- The X12 Transaction Map: 834 to 835 and Everything in Between
- X12 837 Part 3: Service Lines (Loop 2400)
- X12 837 Part 2: The Claim Information Loop (2300)
- X12 837 Part 1: Submitter, Receiver, Provider, Subscriber and Patient Loops
- X12 278: Prior Authorization Request and Response
- Introduction to Healthcare EDI and ANSI X12
- The US Healthcare Ecosystem: Who's Who
- HIPAA Explained: Covered Entities, Business Associates and the Rules
- Value-Based Care, ACOs and Alternative Payment Models
- Risk Adjustment and HCC Coding
- Quality Measures: HEDIS, Star Ratings and MIPS
- Healthcare Claims Data and Analytics
- Revenue Cycle Management (RCM) End to End
- Remittance, EOB vs ERA and Payment Posting
- Patient Registration and Eligibility & Benefits Verification
- Coordination of Benefits: When a Patient Has Two Plans
- The Claim Lifecycle: From Submission to Adjudication
- Claim Denials and Appeals
- HL7 v2 Messages: ADT, ORM, ORU and SIU
- FHIR Fundamentals: Resources, REST APIs and SMART on FHIR
- EHR, Practice Management and Payer Core Systems
- Medical Imaging Systems: DICOM, PACS and RIS
- CMS Interoperability and Prior Authorization Rule: Payer FHIR APIs
- Employer Coverage, ERISA and the ACA Marketplace
- Parsing and Validating X12 Files in Code
- Building a HIPAA-Compliant Architecture on AWS, Azure and GCP
- Healthcare Data Services in the Cloud: AWS, Azure and Google Cloud
- AI in US Healthcare: Prior Auth, Coding and Claims Automation
- X12 835: Claim Payment and Remittance Advice
- X12 834 and 820: Enrollment and Premium Payments
- X12 276/277, 277CA and 999: Claim Status and Acknowledgments
- X12 270/271: Eligibility and Benefits Inquiry
- How Money Flows in US Healthcare
- Healthcare Identifiers: NPI, TIN, Taxonomy, Payer ID and Member ID
- PHI, the 18 Identifiers and the Minimum Necessary Standard
- No Surprises Act and Price Transparency