Changes to Electronic Remittance Advice and Electronic Funds Transfer take effect Jan. 1, 2014

You may be aware of the Affordable Care Act and the changes relating to patients and businesses, but you may not know that the ACA also affects the electronic Health Information Portability and Accountability Act standard transactions.

The ACA has defined mandated operating rules through the Council for Affordable Quality Healthcare and the Committee on Operating Rules for Information Exchange that will augment the current HIPAA standard transaction guidelines. For more information on these guidelines, click here.

Two of the operating rules that specifically relate to the HIPAA-mandated 835/ERA standard transaction are CORE 382 ERA Enrollment Data Rule and CORE 360 Uniform Use of Claim Adjustment Reason Codes and Remittance Advice Remark Codes 835 Rule, with a mandated effective date of Jan. 1, 2014.   

1. CORE 382 ERA Enrollment Data Rule mandates that health plans are required to offer electronic enrollment for 835/ERA at a minimum and must use standardized templates to collect data for these enrollments.
   
   If you’ve already enrolled to receive the electronic 835/ERA, you do not have to enroll again. However, if you wish to make an update or cancel your current enrollment or if you are enrolling for the first time, you need to be aware of these changes.
   
   To complete the new ERA enrollment, log in to the Trading Partner Agreement and Provider Authorization tool using your assigned Provider Trading Partner Agreement ID and password. 
   
   ERA enrollment instructions will display as an option on the Trading Partner Agreement Provider Menu screen. If you choose to receive an electronic 835/ERA, complete the appropriate provider authorization to be directed to the 835 Enrollment Form.
   
   
2. CORE 360 standardizes the use of adjustment reason and remark codes in the 835/ERA transaction into four different business scenarios:
• Business Scenario #1: Additional Information Required — Missing/Invalid/Incomplete Documentation
• Business Scenario #2: Additional Information Required — Missing/Invalid/Incomplete Data from Submitted Claim
• Business Scenario #3: Billed Service Not Covered by Health Plan
• Business Scenario #4: Benefit for Billed Service Not Separately Payable

These changes will allow for a more consistent use of the reason and remark codes by payers for auto-posting of the 835 electronic remittance information. The new listing of codes, organized by business scenario, is available on the CAQH/CORE website.

Another operating rule relating to both EFT and 835/ERA

3. CORE 370 EFT and ERA Reassociation (CCD+/835) Rule mandates delivery of an ERA and EFT to be within three business days of each other if you’re set up for both.
   
   
Blue Cross Blue Shield of Michigan is required to advise health care providers to notify their financial institution or bank that they have enrolled to use EFT. In addition, providers should request that their financial institution or bank return a health plan payment reassociation number to them in CCD+ format. The reassociation number, located in the addenda record of the banking EFT CCD+ data elements, is necessary for reassociation or tracing of the EFT to ERA in a provider’s accounts receivable or practice management system. When addressing this with your financial institution, it’s recommended that you speak with the branch manager about obtaining the reassociation number.

Final operating rule relating to EFT only

4. CORE 382 ERA Enrollment Data Rule mandates that health plans are required to offer EFT to all providers and must use standardized templates to collect data for these enrollments.

BCBSM and BCN require all professional providers to use electronic funds transfer. If you’re not, please follow these online instructions to begin receiving electronic payments from the Blues. All BCBSM PINs associated with the NPIs for which you submit claims must be registered for EFT. EFT offers you faster access to your payments and there’s no cost to participate.

BCBSM hospital and facilities have access to online vouchers today but will be able to register for Electronic Funds Transfer beginning Dec. 6, 2013.

To register please follow these steps:

• Log in to Provider Secured Services.
• Scroll down to Electronic Funds Transfer, located on the left side of the screen.
• Click on Register Provider.
• Complete the information and submit.

Please allow three to five weeks for processing. Once the registration process is complete, all funds for the registered NPI will be sent electronically.

Note for Blue Care Network providers: If you enrolled for EFT directly with BCN, you will need to enroll with BCBSM through Provider Secured Services.

Professional providers or hospitals and facilities that currently do not have access to Provider Secured Services are encouraged to enroll for access as soon as possible. This will ensure that your staff has the access needed on or after Dec. 6, 2013, to register for EFT or be able to view the remittance advice vouchers online when they’re no longer provided on paper.

Need help?

• If you need help accessing online remittance advices, signing up for Provider Secured Services or Electronic Funds Transfer, contact your BCBSM provider consultant or BCN provider representative.
  
  For technical assistance, you also can call the BCBSM Web Support Help Desk at 1-877-258-3932, Monday through Friday from 8 a.m. to 8 p.m.

• For questions or help with 835/ERA, contact the BCBSM EDI Help Desk at 1-800-542-0945, Monday through Friday, from 8 a.m. to 4:30 p.m.

Additional information is available in the October edition of The Record and in this issue.

BCBSM does not guarantee or warrant the validity of information provided on third party websites. The information in this document is not intended to impart legal advice. If you have any legal questions about the information contained in this document, you should consult your attorney or other professional legal services provider.