HHS Issues New Rule on Electronic Claim Payments

Proposal Would Save Up to $9 Billion over Decade

Health and Human Services (HHS) Secretary Kathleen Sebelius said Tuesday that a new rule for making health care claim payments electronically would save up to $9 billion over the next decade.

“These new rules will cut red tape, save money and ensure doctors spend more time seeing patients and less time filling out forms,” said Sebelius.

By receiving payments electronically and automating the posting of the payments, administrative time and costs can be decreased. The operating rules build upon industry-wide health care electronic fund transfer (EFT) standards that HHS adopted in January of this year. Together, the previously issued EFT standards and the EFT and electronic remittance advice (ERA) operating rules are projected to save between $2.7 billion and more than $9 billion in administrative costs over 10 years by reducing inefficient manual administrative processes for physician practices, hospitals, and health plans.

Operating rules include best business practices on how electronic transactions are transmitted and often target obstacles that physician practices and health insurers have with using electronic transactions. For instance, the rule announced today requires insurers to offer a standardized, online enrollment for EFT and ERA so that physicians and hospitals can more easily enroll with multiple health plans to receive those transactions electronically.  The rule also requires health plans to send the EFT within a certain amount of days of the ERA, which helps providers reconcile their accounts more quickly.

The rule, Administrative Simplification:  Adoption of Operating Rules for Health Care Electronic Funds Transfers (EFT) and Remittance Advice Transactions were developed through extensive discussions with industry stakeholders. The rule adopts the Council for Affordable Quality Healthcare’s Committee on Operating Rules for Information Exchange (CAQH CORE) Phase III EFT & ERA Operating Rule Set, including the CORE v5010 Master Companion Guide Template, with the exception of Requirement 4.2 of the Phase III CORE 350 Health Care Claim Payment/Advice (835) Infrastructure Rule.    Collectively, these rules are referred to as the EFT & ERA Operating Rule Set .

The regulation announced today may be viewed at www.ofr.gov/inspection.aspx and will be effective upon its publication in the Federal Register on Aug. 10, 2012.  The comment period closes on Oct. 9, 2012. The compliance date for operating rules for the health care electronic funds transfers and remittance advice transaction is Jan. 1, 2014.