Healthcare EFT Payment Options: Why Choose ACH?

The Patient Protection and Affordable Care Act (ACA) identified NACHA’s CCD+Addenda as the HIPAA healthcare Electronic Funds Transfer (EFT) standard for payments processed through the ACH Network. With an implementation date of January 1, 2014, providers around the country are weighing their options, looking for ways to save time and money.

With so many choices available, how does the ACH Network compare to other payment types cited in the final rule? What are the providers’ rights to request and receive claims through the ACH Network?

Compare Healthcare EFT Payment Options

Answers to these choices can be found below:

Comparison of Electronic Payment Options
  Healthcare EFT Standard (via ACH) Virtual Card Wire Transfer
Funds availability (as measured from the time that a plan initiates a payment) Next Day 2-3 business days depending on card type and agreement with Merchant Card Processing Provider (funds deposited to bank account via ACH Network) Same day (funds irrevocable)
Average cost to receive $2,500 EFT payment $0.34 (any payment value)1 Percentage of total payment plus a transaction fee. Example--3% interchange fee on $2,500 payment and $0.10 transaction fee = $75.10 $10.73 (any payment value)2
Enrollment/acceptance Must have bank account; one time with each health plan Must have a bank account and agreement with a merchant card processing provider, and point of sale processing system/terminal Must have a bank account; one time with each health plan (account information must be provided to each health plan)
Risk Very low risk with ACH credit payment; FI can support additional account monitoring tools such as debit filters or blocks Higher risk with virtual cards; card numbers mailed or faxed have information that can be used by anyone with ability to accept card payments Very low risk with immediate payment
Manual processing for each payment None--automatically deposited to bank account Each payment must be manually entered into the POS terminal by office staff None--automatically deposited to bank account
Reassociation with electronic remittance information Standardized inclusion of TRN Reassociation Data Segment in payment; delivered by financial institution after service is established Not included with payment; manual access to each EOB through Web portal No requirement to include TRN Reassociation Data Segment with payment; if included, can be delivered by financial institution after service is established

Providers Benefit from Choosing ACH

All providers have the right to request and receive claims reimbursements via the ACH Network. Under HIPAA (45 CFR § 162.925), health plans must deliver the claims reimbursement payment, when requested, starting January 1, 2014. 

The benefits to the provider of requesting claims reimbursement through the Network are many:

  • Easy, Automatic Payments – Receiving healthcare EFTs via ACH is as quick as receiving Direct Deposit via ACH.
  • Improved Cash Flow – Healthcare EFTs via ACH ensure funds are available up to 7 days faster than with paper checks.
  • Safe and Secure – Checks continue to be the dominant payment form targeted by fraudsters. Replacing all checks with healthcare EFTs via ACH is the single best way to combat fraud.
  • Automatic Reassociation – Only healthcare EFTs via ACH offer providers the ability to automatically reassociate remittance information.
  • Consistent with Medicare – Beginning January 1, 2014, Medicare will be implementing healthcare EFTs via ACH for all claims reimbursements, creating accounts receivable consistencies.
  • Smart, Cost-Effective Choice – The cost of claims via ACH is, on average, only $0.34 versus $10.73 or more for other EFT payment types.

To learn more, visit the American Medical Association’s website.

[1] The Blue Book of Bank Prices 2012-13 published by Phoenix-Hecht -

[2] Ibid