New EFT rule: How does it impact you?


On Aug. 10, the U.S. Department of Health & Human Services released a new version of the interim final rule adopting the CAQH CORE Operating Rules, which better positions providers to improve efficiency and reduce administrative costs. Here’s what the new rule means for providers:

Reduce time and costs to reconcile payer payments and remittances
The rule mandates that payers delivering EFT payments to providers must use the CCD+ file format. This allows payers to efficiently and securely include the trace number, which enables providers to re-associate the ERA with the EFT.  Therefore, providers can reconcile payments and remittances automatically, reducing hours of manual administrative work.

Get paid faster
Providers will receive electronic payments faster than paper checks, which enables them to identify remaining patient responsibility and bill patients sooner.

Streamline processes with reporting on remittances
By receiving fully reconciled remittances electronically, providers can access summary reports on all remittances to save administrative time and costs.

Apply best practices
The latest version of the rule better positions providers to reduce their administrative costs. However, the rule specifies that providers need to “apply best practices to transmitting and receiving [ERA/EFT] transactions” in order to achieve administrative efficiency.  Here are a few tips:

  • Ensure staff members can access detailed, customizable reports for all transactions so they can easily view and update all information in real time.
  • Leverage a private cloud that ensures that all data is safe. (Click here for a list of questions to ask vendors about their availability.)
  • Manage all transactions through a private cloud that is not only compliant but also independently certified and audited against the Payment Card Industry Data Security Standards (PCI-DSS) and HIPAA. (Check MasterCard, Visa and EHNAC for a list of independently certified solutions/vendors.)
  • Use a CAQH CORE-certified clearinghouse to ensure transactions are compliant with new regulations. (Click here for a list.)