April 23—The Centers for Medicare & Medicaid Services (CMS) has finalized operating rules for healthcare electronic funds transfer (EFT) and electronic remittance advice (ERA) required by the Affordable Care Act (ACA). The rule finalizes without changes the interim final rule, issued by the U.S. Department of Health and Human Services in August 2012.

The final rule sets a standard EFT/ERA enrollment data element set with master templates for all health plans to adopt, as opposed to providers having to separately enroll for EFT and ERA with each health plan they accept. The rule adopts operating rules developed by the Council for Affordable Quality Healthcare’s Committee on Operating Rules for Information Exchange, which link the remittance advice with the fund transfer so healthcare providers can match or “reassociate” the EFT and the corresponding ERA transmissions when they arrive separately.

The ACA specifies that all commercial health plans must adopt EFT and ERA operating and standards rules by Jan. 1, 2014, and certify they have the ability to facilitate these transactions, should a provider request an electronic remittance. All payments under Medicare must be submitted by EFT beginning in January 2014.

Publication Date: Tuesday, April 23, 2013