Bob Hough, Director of Operations at Geisinger Health plan (GHP) recently authored a piece for Managed Care Magazine on how GHP transitioned to the InstaMed Network to streamline and consolidate the provider payment process while resolving the significant challenges associated with paper checks and explanation of payments (EOPs).
Read the full article, Geisinger: All-in and Thumbs-up On Electronic Payment to Providers, in Managed Care Magazine. Below is an excerpt from the article.
January 2018 marked the fourth anniversary of the federal mandate that requires all payers to support electronic funds transfer (EFT) and electronic remittance advice (ERA) transactions to providers. The mandate, known as the CAQH CORE Phase III Operating Rules, was developed in part with a broader set of rules that were aimed at streamlining inefficient processes surrounding health care payment transactions. Essentially, electronic transactions were set forth in the federal mandate as a way to decrease the costs, delays, and errors that inherently come with paper transactions.
The Phase III Operating Rules mandate requires not only that payers offer provider networks with electronic payments, but also that those payments include the EFT trace number with the remittance to allow for reassociation with the ERA. The mandate further defines requirements around uniform use of claim adjustment reason codes (CARCs) and remittance advice remark codes (RARCs), ERA/EFT enrollment standards, ERA/EFT association standards, and claim payment and remittance infrastructure standards.