NACHA Membership Approves Rule Supporting Fully Electronic Health Care Claims Payments via ACH

Posted November, 27 2012

FOR IMMEDIATE RELEASE

Contact:
NACHA
703-561-3925
media@nacha.org 

NACHA Membership Approves Rule Supporting Fully Electronic Health Care Claims Payments via ACH

Health Care Payments via ACH Will Help Health Plans and Health Care Providers Utilize Health Care EFT Standard and Operating Rules by January 2014 Compliance Date

HERNDON, Va., November 27, 2012 – NACHA – The Electronic Payments Association has adopted a new health care payments rule as part of the NACHA Operating Rules.  The rule supports health plans’ and health care providers’ use of the ACH Network for electronic health care claims payments, and the electronic “reassociation” of these payments with electronic remittance advices (ERAs).

“Any health care provider with a bank account will be able to receive a health care electronic funds transfer (EFT) via ACH, just like a Direct Deposit,” said Janet O. Estep, NACHA president and CEO.  “Providers will benefit from faster deposits and access to funds, and cost savings from not having to deposit paper checks.  Payers will also benefit from replacing the printing and mailing of paper checks with electronic payments via ACH.”

Currently, only 33 percent of payments from health plans to health care providers in the U.S. are made electronically, according to industry estimates.[1]  With the adoption of standards and rules for health care EFTs and ERAs, the health care industry is poised to save between $3.1 and 4.5 billion over the next 10 years through greater use of electronic transactions.[2]

The NACHA rule standardizes the use and the data content of NACHA’s “CCD+” transaction when used for health care EFTs, making the payment readily identifiable to health care providers.  The rule requires the inclusion of the reassociation number with the EFT as part of a single electronic message. The reassociation number is used by a health care provider to link the payment to a remittance advice that explains which claims are being paid.  With these enhancements, a health care EFT via ACH is the only fully electronic method for health care claims payments and reassociation that drives savings to all parties.

NACHA’s new rule complements the health care EFT and ERA standards recently designated by the Department of Health and Human Services’ (HHS)[3], and the health care operating rules for EFT and ERA developed by the Council on Affordable Quality Healthcare (CAQH) Committee on Operating Rules for Information Exchange (CORE)[4]. Significantly, the CORE rules will standardize and substantially streamline providers’ enrollment for EFT.  The NACHA Rule, which will be become effective on September 20, 2013, will help ensure that financial institutions are ready to send and receive health care payments for health plans and health care providers using the health care EFT standard by the January 1, 2014, compliance deadline established under the Patient Protection and Affordable Care Act.

For more information about the new health care EFT and ERA standards, health care operating rules for EFT & ERA, and other health care payments news, visit NACHA’s Healthcare Payments Resource Site at http://healthcare.nacha.org.

_____________________________________________________________________
[1] 45 CFR Part 162 Administrative Simplification: Adoption of Operating Rules for Health Care Electronic Funds Transfer (EFT) and Remittance Advice Transactions; Final Rule, Table 6 – EFT and ERA Usage for Medicare, Medicaid and Other Government Health Plans, and Commercial Health Plans Between 2013 and 2023
[2]45 CFR Parts 160 and 162 Administrative Simplification:  Adoption of Standards for Health Care Electronic Funds Transfers (EFTs) and Remittance Advice, Table 19 – Total Costs and Savings of Implementing the Health Care EFT Standards for Health Care Industry
[3]  45 CFR Part 162 Administrative Simplification:  Adoption of Operating Rules for Health Care Electronic Funds Transfer (EFT) and Remittance Advice Transactions; Final Rule
[4] http://www.caqh.org/CORE_phase3.php

Access: Public