HHS Adopts Operating Rules for EFT, ERA

Interim final rule requires use of a trace number to match remittance advice with the corresponding EFT payment to eliminate manual reconciliation.

Insurance Networking News, January 6, 2012

Joseph Goedert

The U.S. Department of Health and Human Services has issued an interim final rule to require adoption of standards and operating rules for electronic funds transfer and remittance advice HIPAA transactions.

Operating rules are designed to tighten and make more uniform the HIPAA standards for electronic administrative/financial transactions. Adoption of a series of operating rules between 2013 and 2016 is mandated under the Affordable Care Act.

CMS in July 2011 published an interim final rule adopting operating rules for the insurance eligibility verification/benefit determination and claim status transactions. The Committee on Operating Rules for Information Exchange within CAQH, an alliance of industry stakeholders is developing many of the operating rules. CORE has worked with the Electronic Payments Association, a banking group, to develop the operating rules for electronic remittance advice and electronic funds transfer transactions.

The interim final rule requires use of a trace number to match remittance advice with the corresponding EFT payment to eliminate manual reconciliation as providers often receive these transactions separately. The rule, with a 60-day comment period, is available here and will be published Jan. 10 in the Federal Register. The compliance date is Jan. 1, 2014.

This article originally appeared on the Health Data Management website.

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