EFT/ERA

As of January 1, 2014, all health plans are required to offer Electronic Funds Transfer (EFT) and Electronic Remittance Advices (ERA) to providers.

CareMore has selected Change Healthcare as its electronic payment and remittance reporting provider. Although you are not required to sign-up for EFT, we encourage you to consider the option.

  • Benefits of signing up with an EFT provider are:
  • Acceleration of the reimbursement cycle since you don’t have to wait for your checks to arrive in the mail.
  • Elimination of manual processes like sorting and opening mail, reconciling paper-based claims payments, creating deposit tickets, and making trips to the bank.

Change Healthcare is an online application available for ePayment users. It allows you to search, view, and print human-readable images of the ERA. Change Healthcare also provides access to downloadable HIPAA-formatted 835 ERA files from Change Healthcare enrolled payers to simplify payment posting.

You can switch from paper to electronic payments over the phone, online, through the mail, or via fax.

There is no cost to you to use Change Healthcare and enrollment is free.

To enroll online go to https://www.changehealthcare.com/ or you can simply call 866-506-2830. If you choose to enroll online, you will receive an email with your account information and instructions for completing your enrollment online.

Helpful Hints for Change Healthcare Enrollment

  • Ensure that you are an authorized representative of the designated provider
  • Have your contact, organization, and financial account information available
  • Supply your NPI in the Provider ID field
  • Review the EFT Frequently Asked Questions on https://www.changehealthcare.com/

Information about the CAQH CORE EFT & ERA Operating Rules is also being provided for your information. Questions about this communication or need assistance from a CareMore representative, please call Provider Relations at 888-291-1358 (Select Option 3, then Option 5).


New EFT & ERA Operating Rules

Frequently Asked Questions (FAQ)

Section 1104 of the Affordable Care Act (ACA) amends Administrative Simplification requirements under HIPAA and calls for a single set of Operating Rules and Standards for certain electronic health care transactions. The new rules are set forth by the Council for Affordable Quality Healthcare (CAQH) and the Committee on Operating Rules for Information Exchange (CORE).

The following frequently asked questions provide additional information about the CAQH CORE EFT & ERA Operating Rules.

What are CORE Operating Rules?

CORE Operating rules are guidelines that refine the existing infrastructure supporting electronic data exchange. Operating rules help increase standardization of electronic health care transactions.

Who must comply with ACA Section 1104?

All HIPAA Covered Entities must comply with the new CORE Operating Rules, as applicable. Covered Entities include health care providers, health plans, and health care clearinghouses that transmit information electronically in connection with a transaction for which HHS has adopted a standard.

When must the new CAQH CORE EFT & ERA Operating Rules be implemented?

Covered Entities must be compliant with the CAQH CORE EFT & ERA Operating Rules by January 1, 2014.

How will the CAQH CORE EFT & ERA Operating Rules impact the provider? What will change?

The CAQH CORE EFT & ERA Operating Rules will primarily impact EFT/ERA (HIPAA 835) transactions. The following are a few of the important changes providers may notice and should be aware of. More specific information about the CAQH CORE EFT & ERA Operating Rules is available here.

  • New rules are intended to help providers more effectively use ERA data to understand the reasons for claim adjustments. They require health plans to uniformly use Claim Adjustment Reason Codes (CARCs), Remittance Advice Remark Codes (RARCs), and Claim Adjustment Group Codes (CAGs) in certain limited scenarios defined by the operating rules.
  • New rules are intended to make it easier for providers to match or "re-associate" ERA and EFT transaction information that may arrive at different times. This can help reduce the number of open accounts receivable. Health plans will be required to adhere to standards for the amount of time permitted to lapse between the transmission of the ERA transaction and the EFT payment. The rules also outline requirements for resolving late or missing EFT and ERA transactions.
  • New rules require financial institutions to have the ability to deliver specific reports to providers to assist with the reassociation of ERA and EFT information. Providers must proactively request this additional reporting from their financial institution.
  • New rules require all health plans to make EFT available, and provide electronic means of enrolling for EFT and ERA, using a consistent set of data elements.

What should providers do to prepare for these changes?

Much of the work to implement the new operating rules is being done by health plans, and the IT vendors, clearinghouses and financial institutions, with whom many providers contract. Providers who outsource their standard transactions should engage in conversations with their clearinghouses, trading partners, financial institutions, and vendors about the status of their implementation efforts. The CAQH CORE Analysis & Planning Guide is available to help you assess impacts to systems and vendors.

Providers will not need to change the way that they currently submit electronic claims to CareMore or to their clearinghouse.

Will these changes cost anything for the provider?

There will be no direct costs to providers from CareMore. However, providers should inquire with trading partners and other vendors to understand additional steps or any charges for services associated with these changes.