Currently, less than one-half of medical claim reimbursements are made electronically. The Affordable Care Act (ACA) is pushing for transformation by implementing compliance initiatives including the mandated 5010 and Healthcare Operating Rules for EFT & ERA. These are driven by CAQH-CORE (The Council for Affordable Quality Healthcare – Committee on Operating Rules for Information Exchange).
To support this initiative, NACHA (National Automated Clearing House Association) has enacted a standard for data content of addenda records in ACH payments which is populated by health plans to clearly identify CCD Entries that are Health Care EFT Transactions through the use of the specific identifier “HCCLAIMPMT”. Incorporated in this record will be the TRN Association (Trace Reassociation Number) data segment as defined by X12 835 TR3 V5010.
These new offerings will certainly help the adoption of electronic payments. However, there are significant challenges which must be overcome for any provider’s implementation:
- Recon Complexity: There can be a 3 to 4 day difference between the reception of the ACH and EDI 835 ERAs… so matching the payments can be complex if done manually.
- Transition to Transformation: During the period of paper and electronic payments, it’s difficult to integrate and reconcile multiple payment sources. For example, EOBs are used for remittances while ACH is used as the payment vehicle.
- System Readiness: Most systems utilized by providers won’t have the logic in place to fully reconcile payments vs. remittances (835 & ACH).
- End of Month Processing: Providers may need to change end of month reconciliation processes.
- EFT Data: Retrieving the EDI data from the NACHA records can be difficult, depending on whether you are a lockbox provider, biller or provider. Variables which make it more difficult for larger providers include: on-us ACHs, use of multiple ACH clearing partners and complexity of DDA account relationships.
If you are perplexed by these challenges, download our white paper called “How to Reassociate EFT/ACH Payments to ERAs in 2014” to learn more at www.orbograph.com/white-papers.