August 16, 2023

News Article Highlights Healthcare Providers’ Concerns Over Fees on Healthcare Claim Payments


Michael Herd

Michael Herd

Senior Vice President, ACH Network Administration



For more than a decade, Nacha has actively encouraged healthcare providers to move away from checks and receive claim payments by ACH. Since January 2014 the Nacha “CCD+Addenda” has been the healthcare EFT standard designated by the Department of Health and Human Services, and Nacha has been designated as the standard maintenance organization for the Healthcare EFT. 

Industry adoption of this standard transaction has been robust: From 2013 through the first half of 2023, healthcare volume on the ACH Network totaled more than 3 billion payments, according to Nacha statistics. Electronic claim payment is the overwhelming choice of medical providers, with nearly 71% of claims paid by ACH in 2021, according to the 2022 CAQH Index. 

Although medical and dental providers have the right to receive claim payments by ACH, those rights are under threat, as a recent article by the independent nonprofit news organization ProPublica found. 

“Insurers now routinely require doctors to kick back as much as 5% if they want to be paid electronically,” ProPublica stated in an Aug. 14 story. “Despite protests from doctors and hospitals, the insurers and their middlemen refuse to back down.”

The ProPublica report echoed Nacha’s efforts. In a March 11, 2014, letter to the Co‐Chairs of the National Committee on Vital and Health Statistics (NCVHS) Subcommittee on Standards, we wrote:

“NACHA has been advised that some providers are being notified that when requesting the delivery of the healthcare EFT standard for claims reimbursement payments that the provider will be charged a percentage of the value of the ACH transaction for the initiation of the payment by the plan’s vendor. In other industries the originator of the transaction does not charge the receiver of the ACH transaction to send an ACH transaction. Allowing the health plans to charge the providers to receive claims reimbursement payment is not consistent with the goals of the [Affordable Care Act] or HIPAA to automate the payment process. With this pricing model the provider is better off financially receiving a check.”

Most recently, in July 2021, when the NCVHS issued a Request for Comment on Healthcare Standards Development, Adoption and Implementation, Nacha conveyed the experience of healthcare providers who are being charged to receive EFTs via ACH: 

“A significant pain point experienced by some providers regards business practices by some payers or their vendors. In many instances, providers have experienced difficulties in enrolling in EFT; [and] that payers or their vendors are charging fees to use the standard transaction…Addressing these existing pain points could go a long way toward increasing adoption of the standard EFT transaction.”

While the ProPublica story highlighted the struggle of one New York physician to get no-fee ACH claim payments, Nacha itself has heard from dentists who have come up against insurance companies pressing them to pay fees for using the standard transaction by ACH. 

To avoid fees, ProPublica reported that many doctors “insist on being paid by paper check.” At a time when check fraud is soaring, does anyone honestly believe this is the best solution? 

Nacha will continue its efforts to encourage medical and dental practices to switch to, or continue with, ACH payments. We firmly believe ACH is the safest, most efficient way for these hard-working professionals to receive the money they have earned.

Learn more about Nacha’s reach out to medical and dental professionals.