New HHS Rule Adopts EFT/ERA Operating Rules

The Department of Health and Human Services has released an interim final rule adopting operating rules to further standardize the HIPAA electronic funds transfer and electronic remittance advice transactions.

The rule, with a 60-day comment period, is available here and will be published Aug. 10 in the Federal Register. Industry stakeholders, working under the Committee for Operating Rules for Information Exchange (CORE) initiative, have been developing operating rules for HIPAA transactions for several years and encouraging voluntary use.

The Affordable Care Act mandates adoption of a series of operating rules between 2013 and 2016. These include operating rules for eligibility and claim status in 2013, EFT and ERA in 2014, and claims/encounters, coordination of benefits, enrollment/disenrollment, premium payments, attachments, and referral certification and authorization in 2016.

Despite the advances of electronic transactions, 70 percent of health care claim payments and 75 percent of remittance advice continues to be sent through the mail in paper form, according to HHS. Federal officials believe use of EFT and ERA operating rules will save between $2.7 billion and more than $9 billion over 10 years by reducing inefficient manual processes.

In the interim final rule, the agency is adopting the Phase III CORE EFT and ERA Operating Rule Set with one exception: “We are not adopting Requirement 4.2, titled ‘Health Care Claim Payment/Advice Batch Acknowledgement Requirements,’ of the Phase III CORE 350 Health Care Claim Payment/Advice (835) Infrastructure Rule because that requirement requires the use of the Accredited Standards Committee (ASC) X12 999 acknowledgement standard, and the Secretary has not adopted standards for acknowledgements.”