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Other payment methodologies are allowed, but all health plans must transmit payments through the Automated Clearing House (ACH) Network.
The adopted EFT/ERA operating rule provides specific guidelines for the EFT and ERA maximum enrollment data set that health plans may require from providers.
There are a couple of important factors to keep in mind when considering the implementation of ACH and the 835, which will impact a provider’s willingness to accept and their ability to process these new transaction types Although the EFT Mandate focuses on ACH payments, it does not prevent a healthcare payer from paying a provider through other electronic means.
The key to successful migration away from paper claim checks and paper EOP advices is for healthcare payers to support multiple electronic payment types and remittance options based on provider preference.
The TRN Segment in the Addenda Record of the CCD Addenda should be the same as the TRN Segment in the associated ERA that describes the payment.
Using the same TRN Segment helps to match the payment to the correct remittance advice, a process called reassociation.
An EFT includes information such as the: An electronic remittance advice, or ERA, is an explanation from a health plan to a provider about a claim payment.
An electronic funds transfer, or EFT, is the electronic message health plans use to order a bank to transfer funds electronically to a provider’s bank account to pay for health care services.
It’s easy for medical and dental providers to be paid electronically.
The Healthcare Electronic Funds Transfer (EFT) standard supports HIPAA-compliant transactions between health plans and providers.
For more guidance on standardized EFT/ERA enrollment data elements please refer to the CAQH CORE operating rules found at Phase III EFT and ERA Operating Rules.
Health plans are required to input the X12 835 TRN Segment into Field 3 of the Addenda Record of the CCD Addenda.