In 2014, all payers were federally mandated to support electronic funds transfer (EFT) and electronic remittance advice (ERA) in accordance with the requirements specified in the CAQH CORE Operating Rules. Though the mandate went into effect in January 2014, the industry has been slow to adopt the electronic alternative to paper checks. Many organizations send a high dollar volume through ERA/EFT, but it’s the low percentage of transactions sent through ERA/EFT that keeps print and mail costs high. The costs
A previous post detailed the latest trends in healthcare payments impacting how providers do business and best practices for providers to meet those challenges. However, the latest trends in healthcare payments present unique challenges for payers, which they must adequately prepare for – or risk consumer dissatisfaction and lost revenue.
Data from the 2013 Trends in Healthcare Payments Annual Report demonstrates that healthcare payments industry is evolving and outlines how payers can manage these changes. In particular, healthcare consumerism and provider
In 2014, all payers will be federally mandated to support electronic funds transfer (EFT) and electronic remittance advice (ERA) in accordance with the requirements specified in the CAQH CORE Operating Rules. Providers may be wondering how this mandate will affect payer payments and what you must do to be compliant.
Under the mandate, providers have no obligation to accept ERA/EFT from payers. However, the mandate enables providers to improve efficiency and reduce administrative costs. Read on to learn more about how
On January 1, 2014, all payers will be required to support electronic funds transfer (EFT) and electronic remittance advice (ERA). When evaluating how to achieve ERA/EFT, one of the first decisions a payer will need to make is to “build or buy” – whether to use internal resources to build ERA/EFT capability or to work with a third-party vendor.
Regardless of which model a payer follows to achieve ERA/EFT, there are several key considerations that need to be included in the
Recently, we posted a list of five things that payers can do now to prepare for upcoming reform mandates (click here to read the post). This post emphasizes the importance of collaborating with other organizations like clearinghouses, trading partners and vendors, in order to achieve compliance with the mandated CAQH CORE Operating Rules. These relationships are crucial regardless of the approach payers take to achieve compliance.
Below is an outline of the three main models payers can use to meet the
What Are Operating Rules?
Under the Patient Protection and Affordable Care Act (PPACA), the Operating Rules (developed by CAQH CORE) define the guidelines and standards for making electronic healthcare transactions more predictable and consistent, so the industry can be more efficient.
Upcoming mandated Operating Rules include:
Eligibility and Claim Status: Phases I and II
Deadline for payer compliance: January 1, 2013
Why providers should care:
With mandated standards for electronic eligibility transactions, it will be easier for providers to connect to payers to verify patient eligibility
What’s ahead for payers?
On January 1, 2013, payers will be required to meet the first set of mandated operating rules for Eligibility and Claim Status, under the Patient Protection and Affordable Care Act (PPACA). Click here to view the complete set of CAQH CORE Eligibility and Claim Status Operating Rules.
What can payers do to prepare?
1. Focus on Education
Frequently, half the battle of preparing for mandates is gathering all of the information you need. CAQH CORE released an analysis and planning
This webinar has already occurred.
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Check back for upcoming webinars in the CAQH and InstaMed Webinar Series!
Don’t miss the latest webinar in the CAQH and InstaMed Webinar Series: Are You Prepared for Federally Mandated Operating Rules? Lessons Learned and Best Practices for Implementation
The deadlines for implementing federally mandated operating rules are fast approaching for payers, providers and vendors. Is your organization prepared?
In this webinar, hosted by CAQH and InstaMed, you will learn:
How payers, providers and vendors can
Guest Blogger: Bill Marvin, President & CEO, InstaMed
In an earlier post, I commented on the HHS interim final rule adopting electronic funds transfer (EFT) standards, which was released in January 2012. In the post, I outlined the following changes needed in order for the new EFT regulations to truly improve efficiency and deliver cost savings for healthcare payers and their provider networks:
1. Add a Trace Number Requirement
The rule should require that the EFT and the electronic remittance advice (ERA) have
Healthcare reform is a major factor driving change in payer-to-provider payments, including the medical loss ratio (MLR) requirement in PPACA. To reduce administrative costs and meet the MLR mandate, payers are implementing more efficient payment delivery methods. One such method is the offering of ERA/EFT, which combines both the payment and the healthcare payment information to enable provider funding, posting and reconciliation. While many payers have been sending providers ERAs (electronic remittance advice) for years, it’s time for payers to