The U.S. Department of Health and Human Services (HHS) has released an interim final rule that could help standardize U.S. health care electronic funds transfer (ETF) and electronic data interchange (EDI) systems.
HHS is adopting operating rules developed by the Council for Affordable Quality Healthcare (CAQH), Washington, for health care EFT transactions and for “remittance advice” transactions.
The term “EDI” can refer to any formal system two parties use to share information over a computer network.
An “EFT” system is a network that users can use to make and receive payments.
“Electronic remittance advice” (ERA) is the message a payer sends to notify the recipient that the payer has sent a payment.
HHS officials say they have adopted most of the provisions in the Phase III of CAQH’s Committee on Operating Rules for Information Exchange (CORE) EFT & ERA Operating Rule Set, including CAQH’s CORE v5010 Master Companion Guide Template.
HHS has not adopted a CAQH proposal regarding health care claim payment batch acknowledgement requirements. HHS Secretary Kathleen Sebelius needs to adopt an acknowledgement standard before she can adopt the batch acknowledgement requirements, and she has not yet adopted the acknowledgement standard, officials say.
HHS released a batch of health care claim EFT regulations in January and health plan ID rules in April. It posted electronic health claim and eligibiliity notice regulations in July 2011.
Members of Congress added EFT and EDI standard-setting authority provisions to the Patient Protection and Affordable Care Act of 2010 (PPACA) in an effort to reduce U.S. health care system administrative costs.