New AMA Guidance on EFT/ERA Operating Rules

The American Medical Association has released free toolkits to aid physicians in understanding and adopting the new HIPAA “operating rules” for electronic funds transfer and electronic remittance advice transactions.


The American Medical Association has released free toolkits to aid physicians in understanding and adopting the new HIPAA “operating rules” for electronic funds transfer and electronic remittance advice transactions.

The rules make the transactions more uniform and provide more information from health insurers to providers, such as a patient’s deductible and the amount remaining. The AMA guidance covers such areas as describing the rules and the benefits, appropriate information technology systems to support the rules, getting started with adoption and questions to ask software vendors.

A feature story in the November issue of Health Data Management explains the dozen operating rules for HIPAA transactions being implemented between 2013 and 2016. Payers are mandated to offer operating rules, starting with eligibility determination and claims status that had a January 2013 compliance date, with EFT/ERA in January 2014 and the rest of the rules in January 2016.

The AHA guidance on operating rules for electronic funds transfer is here with electronic remittance advice guidance here.

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