NACHA Issues Healthcare Payments and Remittance Processing Request for Comment—Responses Due Friday, April 27, 2012

NACHA issued a Request for Comment (RFC) containing a proposal to amend the NACHA Operating Rules to support specific remittance processing enhancements requested by the healthcare industry. The proposal would establish specific identification and addenda requirements for healthcare claim payments transmitted over the ACH Network. Responses are due by Friday, April 27, 2012.

The proposal includes three possible options for addressing the requested improvements:

• Option #1:  Automatic, electronic delivery of CORE-required Minimum CCD+ Reassociation Data Elements[1] to Healthcare Providers within 2 banking days of settlement.
• Option #2: Electronic delivery of CORE-required Minimum CCD+ Reassociation Data Elements to Healthcare Providers within two banking days of settlement, upon request.
• Option #3: Automatic delivery of CORE-required Minimum CCD+ Reassociation Data Elements to Healthcare Providers within 2 banking days of settlement; no specific manner of delivery prescribed by the Rules.

The RFC, which is available online through April 27, includes more details as well as a comparison of options.

Participant Benefits

The proposal, if adopted, would establish a minimum service level for delivery of healthcare remittance information, improving efficiencies, and benefiting ACH Network participants.

ACH Operators may benefit as well by increasing the demand for their EDI delivery service options. Today, the ACH Operators offer a variety of EDI delivery options as a service to their RDFI customers. RDFIs could use these services more widely for healthcare payment processing without a significant cost or implementation burden.

At a global level, the adoption of the proposal would address one of the major barriers to provider adoption of ACH for claims reimbursement, the delivery of the reassociation trace number in the remittance data.  Increased provider acceptance of ACH claims reimbursement would help the healthcare industry and the nation in bringing down the overall administrative costs of healthcare.

Participant Costs

ODFIs and Originators of Healthcare EFT Transactions would incur one-time programming costs to adopt the use of new codes and descriptions required for these payments.

RDFIs would incur programming costs to identify CCD entries specifically flagged as Healthcare EFT Transactions. RDFIs not already providing data that is equivalent to the CORE-required minimum CCD+ Reassociation Data Elements in the required format would need to modify their systems to allow these data needs.

Healthcare providers should not incur any direct costs related to adoption of this proposal.

NACHA welcomes your comments. Please be sure that appropriate departments and staff within your organization have an opportunity to review this RFC as your organization prepares its response. Submit your response by Friday, April 27, 2012 to the attention of Maribel Bondoc, Manager, Network Rules, NACHA, 13450 Sunrise Valley Drive, Suite 100, Herndon, VA 20171, e-mail: mbondoc@nacha.org.