A mandatory uniform standard for health plans to pay claims electronically was adopted in rules issued Jan. 5 by the U.S. Department of Health and Human Services (HHS). The rules are designed to help health care providers match payments received with the “remittance advice” transactions that plans are already sending them under an existing HHS standard.
Health plans must comply by Jan. 1, 2014, with the electronic funds transfer (EFT) standard, which the health reform law required HHS to add to the eight transaction standards it issued in 2000 under HIPAA. HHS’ interim final rules, scheduled for Jan. 10 publication in the Federal Register, specify the format and data content of the transmission a health plan sends to its bank directing it to pay a health care provider electronically.
“Currently when a provider submits a claim electronically for payment, a health plan often sends a Remittance Advice separately from the [EFT] payment,” making it “difficult or sometimes impossible for the provider to match up the bill and the corresponding payment,” HHS stated in announcing the rules, which require plans to use a tracking number that automatically matches the two.
Rather than add EFT to the HIPAA rules as a separate transaction, HHS amended the existing “health care payment and remittance advice” standard to include EFT. The new standards cover only the “payment initiation” from a health plan to its financial institution, not the bank’s transfer to the recipient provider’s bank.
Health plans that have their bank convert transactions to HIPAA-standard format may continue to do so, but if the bank fails to comply, the plan could be liable for violations. Along with the EFT standard, the Patient Protection and Affordable Care Act will impose “compliance certification” requirements and potentially stiff penalties on health plans (HHS will address these in later rules).
HHS is accepting comments on the interim final EFT rules until March 9.
HIPAA’s transaction standards are covered in the Employer’s Guide to HIPAA and Employer’s Guide to HIPAA Privacy Requirements.
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