EFT / ERA Operating Rules
The CAQH Committee on Operating Rules for Information Exchange (CORE®) developed the Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) Operating Rules for their voluntary Phase III certification program. The Phase III Operating Rules were adopted by CORE in June, 2012.
The Phase III rules address the following transactions:
- The 5010 version of the ASC X12N Health Care Claim Payment/Advice (835)
- The 2011 specification of the Automated Clearing House (ACH) Cash Concentration/Disbursement plus Addenda (CCD+)
The Phase III Operating Rules are as follows:
- Phase III CAQH CORE 350 version 3.0.0: Health Care Claim Payment/Advice (835) Infrastructure Rule and CAQH CORE v5010 Master Companion Guide Template
- Phase III CAQH CORE 360 version 3.0.0: Uniform Use of CARCs and RARCs (835) Rule and CORE-required Code Combinations for CORE-defined Business Scenarios
- Phase III CAQH CORE 370 version 3.0.0: EFT & ERA Reassociation (CCD+/835) Rule
- Phase III CAQH CORE 380 version 3.0.0: EFT Enrollment Data Rule
- Phase III CAQH CORE 383 version 3.0.0: ERA Enrollment Data Rule
Phase III rules establish the following requirements:
- Minimum CCD+ data elements required for reassociation of the EFT with the ERA
- Publication of procedures for resolution of lost or missing EFT’s or ERA’s
- Maximum allowable elapsed time between issuance of the ERA and EFT
- Dual delivery of ERA’s and paper remittance advices following ERA enrollment
- Availability of online EFT and ERA enrollment
- Uniform format and flow of online and paper EFT and ERA enrollment forms, together with a prescribed maximum set of data elements that are allowed to be collected
- EFT payments if requested by the provider
- Uniform usage of Claim Adjustment Reason Codes (CARC), Remittance Advice Reason Codes (RARC), Claim Adjustment Group Codes (CAGC), and NCPDP Reject Codes in the ERA, per defined business scenario
- Display of CARC, RARC, CACG, and NCPDP Reject Code descriptions and associated business scenarios on ERA product interfaces
- Support of batch processing of the Health Care Claim Payment/Advice (835)
- Use of the ASC X12 Acknowledgments for Health Care
- Health Care Claim Payment/Advice (835) companion guide format and flow
- Provision of a “Safe Harbor” connectivity option as defined by the Phase I and II Operating Rules
- Maintenance processes for CARC and RARC code combinations and ERA/EFT enrollment data
On August 10, 2012 the Department of Health and Human Services published the Administrative Simplification: Adoption of Operating Rules for Health Care Electronic Funds Transfers (EFT) and Remittance Advice Transactions; Final Rule which required HIPAA covered entities to conform to a subset of the CAQH CORE Phase III Operating Rules.
Although this Final Rule adopted the majority of the CORE Phase I II Operating Rules, it excluded rules referencing acknowledgments and CORE certification.
All Change Healthcare products and services comply with the ERA and EFT Operating Rules IFC.
CAQH CORE offers a voluntary certification program which serves to demonstrate an entity’s conformance to the Phase III Operating Rules.
The federally issued Administrative Simplification: Adoption of Operating Rules for Health Care Electronic Funds Transfers (EFT) and Remittance Advice Transactions; Final Rule excluded rules referencing acknowledgements and Core Certification.
Change Healthcare is CORE® Phase III certified for Remittance and Payment Management Services.