Matthew Dragiff Vice President, Product Management SunGard’s AvantGard

Brief History

On March 23, 2010, the Patient Protection and Affordable Care Act (PPACA) was signed into law.  Section 1104 of the PPACA requires the adoption of operating rules for health care electronic funds transfers (EFT) and electronic remittance advice (ERA) transactions.  The goal of section 1104 is to reduce the administrative burden on healthcare providers by lessening the time and labor spent interacting with multiple health insurance plans, often referred to as billing and insurance related (BIR) tasks.

During 2010, NACHA collaborated with the Council for Affordable Quality Healthcare (a non-profit alliance of health plans and trade associations) Committee on Operating Rules for Information Exchange (CAQH CORE) on a research project to better understand how health plans and providers use EFTs and ERAs.

In December of 2010, a hearing was held by the National Committee on Vital and Health Statistics (NCVHS).  The NCVHS engaged in a comprehensive review of potential standards and operating rules for the EFT and ERA transactions.  The hearing included public testimony by stakeholders representing a cross section of the health care industry, banking industry and standards development organizations.

In March of 2011, NCVHS recommended to the Secretary of Health and Human Services (HHS) that CAQH CORE and NACHA draft the healthcare operating rules for EFT and ERA transactions.  Over the next 6 months, a working group developed operating rules that addressed barriers to healthcare providers’ acceptance of EFT and ERA.

In December 2011, the NCVHS recommended to the Secretary of HHS that the health care EFT standard for payments made via ACH be the NACHA CCD+ format and that the ERA content be as specified in the X12 835 TR3 Report.

On January 10, 2012, the Administrative Simplification: Adoption of Standards for Health Care electronic Funds Transfers (EFTs) and Remittance Advice; Interim Final Rule was published in the Federal Register. This regulation became effective on that date and has a compliance date of January 1, 2014.

On August 10, 2012, the Administrative Simplification: Adoption of Operating Rules for Health Care electronic Funds Transfers (EFTs) and Remittance Advice; Final Rule was published in the Federal Register. This regulation became effective on that date and has a compliance date of January 1, 2014.