Health Care Electronic Funds Transfers (EFT) and Remittance Advice Transactions Interim Final Rule

Centers for Medicare & Medicaid Services (CMS) sent this bulletin at 04/19/2013 08:27 AM EDT
Centers for Medicare & Medicaid Services

 

Health Care Electronic Funds Transfers and Remittance Advice Transactions Interim Final Rule

 

Notice to Industry April 19, 2013

 

On August 10, 2012, the Department of Health and Human Services (HHS) published in the Federal Register an interim final rule with comment period (IFC) adopting operating rules for the health care electronic funds transfers (EFT) and remittance advice transactions (herein referred to as the EFT & ERA Operating Rule Set IFC) under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). These operating rules are authored by the Council for Affordable Quality Health Care Committee on Operating Rules for Information Exchange (CORE).

 

As stated in the IFC that if we received comments that compelled us to change any of the policies in the IFC, we would seek to finalize such changes to allow industry sufficient time to prepare for compliance. After careful review and consideration of all the comments, we have decided not to change any of the policies established in the EFT & ERA Operating Rule Set IFC.

 

We emphasize that the EFT & ERA Operating Rule Set IFC is a final rule that is in effect now, which means industry implementation efforts should be underway for the January 1, 2014 compliance date.

 

We understand from industry that there is some confusion about covered entities’ obligations under the IFC in light of CORE’s ongoing maintenance of CORE-defined Claim Adjustment Reason Code (CARC)/Remittance Advice Remark Code (RARC)/Claim Adjustment Group Code (CAGC) and NCPDP Reject Code combinations. We address these concerns in a separate Notice titled “CORE Code Combination Maintenance Process in the EFT & ERA Operating Rule Set” that will be released after this notice.

 

For free copies of the EFT & ERA Operating Rule Set, visit the CAQH website at

http://www.caqh.org/

 

Covered entities must comply with the EFT & ERA operating rules by January 1, 2014. However, there are no prohibitions against using the operating rules before that date. In fact, HHS encourages entities to use the operating rules with willing trading partners because of the benefits and efficiencies that can be enjoyed by both health plans and providers. HHS also encourages stakeholders to be involved with the CAQH CORE development of new operating rules for the remainder of the transactions.


 

 
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