ERA / EFT
The ASC X12N Health Care Claim Payment/Advice (835) transaction, also known as the Electronic Remittance Advice (ERA) is used by health plans to communicate details concerning the adjudication of a claim. Information provided by the ERA includes:
- Amounts paid
- Reasons for adjustments or denials
- Patient financial liability that has been applied
- Bundling or splitting of payments
- Payment method, such as check, electronic funds transfer
When payment is made by electronic funds transfer (EFT), the EFT and the ERA are almost always sent through different networks and are often received by healthcare providers at different times.
A common method for transmitting an EFT is via the Automated Clearing House (ACH) network, utilizing the NACHA Cash Concentration/Disbursement plus Addenda (CCD+) format. Placement of the TRN segment of the ASC X12N Health Care Claim Payment/Advice into the Addenda record of the CCD+ allows the provider to re-associate the payment with the ERA.
The current mandated version of the ASC X12N Health Care Claim Payment/Advice (835) is 005010.
The Technical Report Type 3 ASC X12N/005010X221A1 Health Care Claim Payment/Advice (835) can be purchased at the ASC X12 Store.
The standard for Healthcare EFT transactions is the Cash Concentration/Disbursement plus Addenda (CCD+) implementation specifications from the 2011 National Automated Clearing House Association (NACHA) Operating Rules and Guidelines.
The TRN segment from the associated ASC X12N Health Care Claim Payment/Advice (835) must be placed in field 3 of the CCD+ Addenda record.
The next anticipated version of the ASC X12N Health Care Claim Payment/Advice (835) is 7030™. This TR3 will be available for public review and comment from November 1, 2016 through January 30, 2017.
EFTUnknown at this time.
The ASC X12N Health Care Claim Payment/Advice (835) and the ACH CCD plus Addenda (CCD+) healthcare electronic funds transfer (EFT) standard are subject to the Administrative Simplification: Adoption of Operating Rules for Health Care Electronic Funds Transfers (EFT) and Remittance Advice Transactions; Final Ruleadopted by the Department of Health and Human Services on August 10, 2012.
CAQH CORE offers a voluntary certification program for their EFT/ERA Operating Rules, which cover the ASC X12N Health Care Claim Payment/Advice (835) and the ACH CCD plus Addenda (CCD+).