Implementing the ERA and EFT Operating Rules

In earlier articles, we talked about the upcoming implementation of the ACA-mandated EFT and ERA Operating rules that will require payers to make available to providers ANSI 835 electronic remittances and EFT procedures for payment processing.  We talked about the benefits of implementing these processes into your revenue cycle workflow to address the problems associated with paper remittances and checks.

Now that this deadline is approaching, providers should be developing a strategy for implementing these processes with payers who currently conduct these transactions on paper.  This begins with getting a list all health plans you do business with and importing this data into a spreadsheet.  Record which ones use paper or electronic remittances and which ones use EFT or checks.  Your goal should be to get everyone switched to the electronic alternative for each transaction.

Once the year ends, begin contacting your payers to request information for enrolling in these transactions.  Although the operating rules require that all payers provide this service, there is not a uniform enrollment process.  Each payer must respond to your request, but you essentially need to communicate with them to establish this flow of information in the new format.  You cannot depend on the payer to initiate the process.

CAQH CORE, the organization that developed these rules, has provided a sample letter that can be used to contact your payers and request the implementation of these transactions.  This document includes additional information about the benefits of the operating rules for providers.

A link to their letter is provided here:

http://www.caqh.org/Host/CORE/EFT-ERA/Sample_Provider_EFT_Request_Letter_to_Health_Plan.pdf

 

By Kalon Mitchell – President, MEDTranDirect

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