CMS: Health Plans Must Honor Provider Requests for Electronic Transfer, Remittance
Apr. 1—Health plans must comply with provider requests for electronic funds transfer and remittance advice as outlined under operating rules and technical standards that went into effect Jan. 1, according to the Centers for Medicare & Medicaid Services (CMS).
In response to a frequently answered question, CMS stated on Friday that if a provider requests that a health plan transmit payments electronically consistent with the HIPAA standard for electronic funds transfer, “The health plan is not permitted to delay or reject a transaction because the transaction is a standard transaction.”
Additionally, when a provider requests that a health plan transfer funds and remittance advice electronically in a standard format by using the automated clearinghouse network, the health plan must comply with the HIPAA standard for such transactions, CMS stated.
Provisions in the Affordable Care Act call for the adoption of electronic funds transfer and electronic remittance advice operating rules and technical standards. The law further states that health plans must have the capability to transmit electronic funds transfer and electronic remittance advice files by Jan.1, 2014, to any provider organization that requests electronic transactions.
But providers are not required to accept electronic payments from health plans, with one caveat: Regulations state that by Jan. 1, 2014, all Medicare payments must be conducted via electronic funds transfer.
For more information on electronic funds transfer and remittance advice, read “Electronic Remissions: What’s the Holdup?” published in the February 2013 issue of HFMA’s hfm magazine.
Publication Date: Tuesday, April 01, 2014