This rule supports the health plans' and health care providers' use of the ACH network for health care claims payments and payment-related information. The rule includes processing enhancements that address specific transaction identification and formatting requirements for health care claim payments in support of The Patient Protection and Affordable Care Act (PPACA).
In July 2012, the U.S. Department of Health and Human Resources (HHS) finalized the Adoption of Standards for Healthcare Electronic Funds Transfer (EFTs) and Remittance Advice (ERAs) These standards are designed to assist providers of healthcare services with reconciling an electronic payment with the electronic remittance by connecting these through a TRN or Trace Reassociation Number.
There are five major components of the rule which are outlined below. For more expanded detail, go to https://healthcare.nacha.org/nacharuleshealthcare.
By Jan. 1, 2014, all health plans are required to be in compliance of the formatting standards for EFT and ERA and must be prepared to pay via ACH if requested by provider.
Effective Sept. 20, 2013, BB&T will begin to pass the reassociation or TRN information to your bank statement free of charge. This information will be available on a next-day basis and will contain the first 57 characters of the addenda record.
Need expanded detail? BB&T has a number of channels for you to receive that information with expanded TRN detail:
For more information you may contact us at 800-810-5625.
ASC – Accredited Standards Committee
CAQH – Council on Affordable Quality Healthcare
CCD – Corporate Credit or Debit
CORE- Required Minimum CCD+ Re-association Data Elements:
CTX – Corporate Trade Exchange
EFT – Electronic Funds Transfer
Electronic Remittance Advice (ERA): – an electronic file that is sent from the Health Plan payer to the Healthcare Provider that can be used to post and close accounts receivable. This is called an ERA or sometimes referred to as an Explanation of Benefits (EOB).
Government programs: – The government may also act as the insurer under sponsored programs such as:
HHS – US Department of Health and Human Services
Healthcare EFT Transaction: – a CCD+ Entry originated by a Health Plan to a Healthcare Provider with respect to a healthcare claim payment. Under this definition, a Healthcare EFT Transaction must include one addenda record that contains 835 TRN (Re-association Trace Number) data segment within the Payment Related Information field.
Healthcare Provider: – a provider of medical or health services, and any other person or organization who furnishes, bills, or is paid for healthcare in the normal course of business.
HIPAA: – the federal law that protects personal medical information and recognizes the rights to relevant medical information of family caregivers and others directly involved in providing or paying for care.
Medical Clearinghouses: – aggregators (senders and receivers) of mountains of medical claim information almost all of which is managed by software.
Tilde (“~”) data segment terminator: – indicates the end of any data segment carried in the Addenda Record of the CCD Entry (alternative to backslash). The tilde is commonly used in the healthcare industry to indicate the end of a healthcare data segment.
ODFI – Originating Depository Financial Institution
RDFI – Receiving Depository Financial Institution
Standards for Healthcare Electronic Funds Transfers (EFTs) and Electronic Remittance Advice (ERAs)
On Jan. 10, 2012, The U.S. Department of Health and Human Services (HHS) issued “Administrative Simplification: Adoption of Standards for Health Care Electronic Funds Transfer (EFT).” This directive of a new standard became final on July 10, 2012.
The standard defined “Healthcare EFT” as a transaction under HIPAA for the first time.
Yes, the standard identified is the NACHA CCD+ Standard Entry Class (SEC) as the EFT standard.
The new EFT standard calls for several changes to be considered a Health Care EFT. More specifically, by using the CCD+ SEC, by default there must be one line of additional remittance information included with the payment, or “addenda.” The addenda information must contain the ANSI ASC X12 TRN (Reassociation Trace Number) data segment found in the TRN 02 position, which conveys the reassociation trace number used by the healthcare provider to match the payment to remittance data (match the dollars to an identifier on the EOB/ERA). Additionally, the standard mandates the receiving bank (e.g. RDFI) must make available this reassociation data no later than the opening of business on the second banking day after the transaction settlement date.
No. As of Jan. 1, 2014, health plans (e.g. insurance companies) and medical providers (e.g. doctors, hospitals, clinics) are not prohibited from using other networks such as wire, card payment networks, etc. However, if a provider requests a health plan conduct EFT using the ACH Network, the health plan is required to do so. Regardless of the network used, every effort should be made by the health plan to ensure that reassociation between the payment and remittance advice can be automated by providers.
Changes to health care specific EFTs will be effective no later than Sept. 20, 2013.
The details within the NACHA Operating Rules and CCD+ standard are being refined to align with Healthcare Operating Rules. To comply with the new rules and be considered a healthcare claim payment the transaction and data must adhere to the following:
If your medical ACH receivers and originators are doctors, medical practitioners, hospitals, health systems, etc. Here is what you need to know:
The new rule mandates if a provider requests a health plan conduct EFT using the ACH Network, the health plan is required to do so. We have found several plans in the marketplace that have updated and complied with this new standard in advance of the September target date. BB&T is able to process these outgoing disbursements via the ACH Network. As the standard is firmly in place by the Sept. 20, 2013, there will likely be more and more adoption and requests by medical providers to receive their health care claim payments via EFT. As such, we advise you to review your processes and procedures so you have a way to indicate to the medical providers how to communicate to you that they wish to begin receiving payments via EFT. Making sure you have these channels of communication and processing in place by Sept. 20 will ensure a positive client experience for all parties.
For additional detail, go to https://healthcare.nacha.org/nacharuleshealthcare
As a receiving depository financial institution (RDFI), BB&T is prepared to comply with all aspects of the new standard and associated rules. BB&T will provide payment-related information upon request by our clients who are receivers (medical providers).
Per the new rules, receiving banks are required to make available the TRN (transaction reassociation number) data by the opening of business on the second banking day following the settlement date of the entry.
At this time, BB&T will not charge fees for this additional data reporting service. However, there may be fees associated with accepting incoming ACH transactions. Please discuss this with your Payments Solutions Treasury consultant.
You should contact your various insurance company partners who process and pay claims to you to determine the best and easiest way to communicate that you would like to begin to receive your payments electronically using the ACH network. Regardless of who the insurance company is, BB&T will present the payment and associated information in compliance with the new EFT Health Care Payments standard.
In conjunction with the new rule, field seven of the Company Batch Header record (a/k/a the “five record” is known as the “company entry description” field will indicate this is a health care claim payment). This field is a mandatory field (it must have data), it can be alpha-numeric and a maximum of 10 characters. The purpose of this field is to provide a description of the transaction to the receiving entity. The new healthcare EFT standard requires the description shall be “HCCLAIMPMT.”
The rules state the CCD entry that is a Healthcare EFT must include one addenda record. Also, the addenda indicator must be populated with a ‘1.’ As such, when populated with a ‘1’, there must be one addenda record. CCD Entries that are healthcare EFT transactions must contain the ANSI ASC X12 TRN (reassociation trace number) data segment, which conveys the reassociation trace number used by the healthcare provider to match the payment to remittance data. (ANSI is the American National Standards Institute; ASC is the Accredited Standards Committee.)
Banks’ ACH processing platforms must support a new “terminating” symbol. In the past, the universally accepted symbol to denote the end of the record was “\”. However, with the new Healthcare EFT standard, the rules call for banks also supporting the tilde (“~”) symbol. BB&T’s ACH processing platform will be updated to support both the prior commonly used standard of the backslash as a terminating symbol as well as the tilde symbol.