States mandating era or eft

Requests for codes must include suggested wording for the new or revised message, and an explanation of how the message will be used and why it is needed.In the complex world of insurance claims payments, insurers and third-party administrators across the U. are seeking new ways to gain efficiencies and savings in their processes.Under HIPAA, all health plans, including Medicare, are required to use claims adjustment reason codes (CARCs) and remittance advice remark codes (RARCs) instead of property codes, to explain any adjustment in the claim payment.X12 is the recognized code set maintainer for the CARCs and RARCs.

This collaboration between Nacha and the healthcare industry came about as a result of the Patient Protection and Affordable Care Act (ACA), which mandated identification of a healthcare EFT standard and the implementation of operating rules for all electronic healthcare transactions by January 1, 2014.

The TRN Segment in the Addenda Record of the CCD Addenda should be the same as the TRN Segment in the associated ERA that describes the payment.

Using the same TRN Segment helps to match the payment to the correct remittance advice, a process called reassociation.

This mandate provides standards and guidelines to promote the migration of healthcare claim payments and explanation of payments (EOPs) from checks to EFTs and electronic remittance advices (ERAs). The ACA EFT Mandate states that a healthcare payer must be able to offer and support electronic claim payments through ACH transactions if the healthcare provider asks for it.

In addition, the mandate specifies that the Electronic Data Interchange (EDI) 835 ERA format must also be sent in support of that payment.

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