News Feature | June 6, 2014

Healthcare EFT Standard, Innovations Seek To Make Accepting Payments Easier

By Megan Williams, contributing writer

Healthcare Pricing And Costs

Chances are your clients are unaware of the time and money they could be saving related to their payment acceptance processes. Here are some recent developments and innovations around electronic funds transfer (EFT) developments in healthcare.

EFTs for healthcare providers have traditionally been a difficult area to navigate. If a provider were interested in receiving EFT payments, they were left to deal with varied enrollment procedures and delayed transactions. Data re-association between payments and claims was non-standardized, making matching difficult.

EFTs And The ACA

The Affordable Care Act made provisions around the issue with a new Healthcare EFT Standard that took effect in January of this year. The standard addresses enrollment, security, and re-association processes in an effort to make accepting payments easier, safer, and more efficient for providers. Benefits should be felt across the board though, making the lives of billers, coders, and IT personnel easier through simple changes including re-association numbers that match outstanding claims for all payments. The system also offers more security and a faster turnaround than paper checks.

Beyond The ACA

The changes don’t stop at the ACA. In collaboration with the National Committee on Vital and Health Statistics, the National Automatic Clearing House Association put together a group of 120 participants from health plans, provider associations, financial institutions, healthcare clearinghouses, standards organizations, pharmacies, dental associations, and NACHA itself to develop a core set of operating rules, designed specifically to address the most pressing difficulties around payments in healthcare.

Key rules the workgroup focused on included:

  • Committee on Operating Rules for EFT Exchange (CORE) EFT Enrollment Data Rule: This rule addresses challenges providers face with variation in data elements and processes when a plan first enrolls in EFT. To receive EFT payments on claims, a provider must enroll with each insurance plan they intend to accept payments from individually. The rule establishes a maximum data element set that plans must adopt for EFT enrollment.
  • CORE ERA Enrollment Data Rule: ERA (electronic remittance advice) enrollment poses a similar challenge for providers. The ERA Enrollment Data Rule also establishes a maximum ERA enrollment data element set that health plans must use for ERA enrollment. It additionally establishes master templates for both paper and electronic enrollment.
  • CORE Uniform Use of CARCs and RARCs (835) Rule: To address the issue of non-uniform and inconsistent CARC/RARC (claim adjustment reason code/admittance advice remark code) combinations for similar business scenarios, this rule identifies four specific business scenarios and establishes a maximum set of CARC and RARC code sets around each.
  • CORE EFT and ERA Reassociation (CCD+/835) Rule: This rule was established to help providers match the EFT payment with the ERA (matching difficulty occurs because of data issues, misunderstandings over standards and operating rules, or a lack of operating rules). In the case that funds are sent separately from the ERA, providers will be able to re-associate those funds by using the ASC X 12 835 EFT re-association trace number.

Solution providers interested in keeping up with developments in payment processing in healthcare will do well to stay on top of ACH developments — it’s grown well beyond just payroll.

According to Bill Sullivan, Senior Director and Group Manager, Government and Industry Relations, NACHA, “The ACH Network is most known for the Direct Deposit of payroll and electronic bill payments, but there are a number of other facets to the Network. Since its inception, it has grown into a robust, flexible and versatile system that has facilitated the continued adoption and growth of electronic payments and information.”

Going Deeper

If you’re interested in reading more from the National Automated Clearinghouse association on payments in healthcare, you can visit the industry-dedicated portion of their site.

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