Commentary: Healthcare EFTs: How to Correct Formatting Errors, Saving Time and Money
Are you using the healthcare electronic fund transfer standard in your practice? The standard allows providers to request that claims payments be made using EFTs via the ACH Network instead of paper checks, and health plans are required to comply.
Are you using the healthcare electronic fund transfer standard in your practice? The standard allows providers to request that claims payments be made using EFTs via the ACH Network instead of paper checks, and health plans are required to comply.
When EFTs via ACH are used in combination with Electronic Remittance Advices (ERAs), providers can realize significant time and costs savings. But the real return on investment is achieved when providers automate the reassociation of the EFT via ACH payment and the ERA and automatically post the receivables. After moving to automation, the Midwest Center for Women’s Healthcare reduced its days in receivables from 25 to 13, and one large hospital group reduced its claim payments processing costs by 70 percent.
To achieve maximum savings, though, the TRN Reassociation Trace Number included in EFT via ACH payments must be formatted correctly and match the TRN Reassociation Trace Number in the corresponding ERA. While the format for the TRN Reassociation Trace Number is defined by ASC X12 (an ANSI standards organization) and included in the healthcare EFT standard, the formatting of the TRN segment in the EFT via ACH payment is not always applied consistently. As a provider, there are steps you can take to help ensure you receive the proper information to support automation of your receivables processes.
If you are experiencing formatting issues with the TRN Reassociation Number provided in your EFT payment:
1. Contact the customer service staff at your health plan and explain the formatting issue. If they are unable to help, ask to speak to the company’s compliance office. Because the healthcare EFT standard and the ERA are both HIPAA standard transactions, the compliance officer should be willing to work with you to correct any problems.
2. If still unsuccessful, consider filing a HIPAA violation with the Centers for Medicare and Medicaid. When a HIPAA violation is reported, the goal of CMS is to correct the problem, not simply levy a fine. CMS also allows HIPAA violations to be filed anonymously. Additional information on filing a HIPAA violation can be found at https://htct.hhs.gov/aset/ASET_home.jsp.
3. Additionally, you can ask your bank to submit a report of a possible ACH Rules violation with NACHA, the standards organization for the healthcare EFT standard. When the standard was identified as the NACHA CCD+Addenda, NACHA added the formatting requirements for the EFT standard and the TRN Reassociation Trace Number to the NACHA Operating Rules. By including these requirements in the rules, NACHA and financial institutions can ensure that the TRN Reassociation Trace Number is being formatted correctly by health plans and their vendors. To report a possible ACH Rules violation, visit www.nacha.org/rules/report-rules-violation.
Incorrectly formatted TRN Reassociation Trace Numbers prevent providers from achieving the full return on investment of automation with EFT and ERA. Make sure you are realizing the full potential of the healthcare EFT standard. To learn more about the standard and its benefits, visit http://healthcare.nacha.org.
Priscilla Holland is senior director of healthcare payments at NACHA, which governs the Automated Clearing House Network.
When EFTs via ACH are used in combination with Electronic Remittance Advices (ERAs), providers can realize significant time and costs savings. But the real return on investment is achieved when providers automate the reassociation of the EFT via ACH payment and the ERA and automatically post the receivables. After moving to automation, the Midwest Center for Women’s Healthcare reduced its days in receivables from 25 to 13, and one large hospital group reduced its claim payments processing costs by 70 percent.
To achieve maximum savings, though, the TRN Reassociation Trace Number included in EFT via ACH payments must be formatted correctly and match the TRN Reassociation Trace Number in the corresponding ERA. While the format for the TRN Reassociation Trace Number is defined by ASC X12 (an ANSI standards organization) and included in the healthcare EFT standard, the formatting of the TRN segment in the EFT via ACH payment is not always applied consistently. As a provider, there are steps you can take to help ensure you receive the proper information to support automation of your receivables processes.
If you are experiencing formatting issues with the TRN Reassociation Number provided in your EFT payment:
1. Contact the customer service staff at your health plan and explain the formatting issue. If they are unable to help, ask to speak to the company’s compliance office. Because the healthcare EFT standard and the ERA are both HIPAA standard transactions, the compliance officer should be willing to work with you to correct any problems.
2. If still unsuccessful, consider filing a HIPAA violation with the Centers for Medicare and Medicaid. When a HIPAA violation is reported, the goal of CMS is to correct the problem, not simply levy a fine. CMS also allows HIPAA violations to be filed anonymously. Additional information on filing a HIPAA violation can be found at https://htct.hhs.gov/aset/ASET_home.jsp.
3. Additionally, you can ask your bank to submit a report of a possible ACH Rules violation with NACHA, the standards organization for the healthcare EFT standard. When the standard was identified as the NACHA CCD+Addenda, NACHA added the formatting requirements for the EFT standard and the TRN Reassociation Trace Number to the NACHA Operating Rules. By including these requirements in the rules, NACHA and financial institutions can ensure that the TRN Reassociation Trace Number is being formatted correctly by health plans and their vendors. To report a possible ACH Rules violation, visit www.nacha.org/rules/report-rules-violation.
Incorrectly formatted TRN Reassociation Trace Numbers prevent providers from achieving the full return on investment of automation with EFT and ERA. Make sure you are realizing the full potential of the healthcare EFT standard. To learn more about the standard and its benefits, visit http://healthcare.nacha.org.
Priscilla Holland is senior director of healthcare payments at NACHA, which governs the Automated Clearing House Network.
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