Health insurer Aetna has a goal of transitioning providers to accepting 100 percent of payments electronically through an electronic funds transfer, as well all providers receiving electronic remittance advice.
Under the Affordable Care Act, the healthcare industry is adopting operating rules that make the HIPAA transaction standards more uniform and include more information in the transaction sets. Insurers were mandated in January 2013 to adopt the operating rules for insurance eligibility determination and claim status, and in January 2014 to adopt rules for EFT and ERA. Providers are not mandated to use the transactions, but there is widespread agreement that they save time and money (see Simplifying Finance: HIPAA Rules).
This year, a growing number of insurers writing new contracts with providers are requiring the providers to agree to go electronic with claims, eligibility, status, remittance advice and payment transactions, says payer consultant Pat Kennedy, president of PJ Consulting Inc. in Rockville, Md. However, the payers generally enable low-volume providers or those retiring in the next year or so to opt out.
Kennedy says for a variety of reasons, no payer will reach 100 percent electronic payments and the goal for most is 90 percent. But while Aetna may consider hardship cases on an individual basis, it has changed its policy on payments and the goal is to have virtually all payments made electronically, says Jay Eisenstock, head of provider e-solutions. Every provider has a banking account, so the transition to electronic payments is not difficult, he adds.
Aetna in recent years has been increasingly offering EFT payments but with Medicares recent move to mandate EFT, Aetna knew the time was right to make its own move. Employees routinely are electronically paid these days and personal electronic banking is common, Eisenstock notes. While payers are required to offer EFT and ERA and benefit from it, the bulk of benefits come when providers take advantage of it.
For now, Aetnas plan for EFT and ERA includes no penalties for non-compliance, Eisenstock says. But the insurer is changing its payment policy and at some point providers not going electronic will have to decide whether to keep their relationship with Aetna.
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