How to Identify the Originator of an EFT via ACH Claim Payment

As a provider, if you receive a healthcare EFT via ACH claim reimbursement payment and you do not recognize the name of the company sending the payment there are a couple of things you can do.

1. Make sure you are receiving the TRN Reassociation Trace Number from your financial institution for all healthcare EFT via ACH transactions.  With this number, you should be able to automatically identify the ERA by matching the TRN Reassociation Trace Number included in the ERA.  Identification of the matching ERA will provide you with the name of the health plan sending the payment.

2. If you are not receiving an ERA for the claim payments and do not recognize the name of the company sending the payment, contact your financial institution (RDFI) and ask the ACH department to contact the Originating Depository Financial Institutions (ODFI)  for more contact information on the Originator.  Once you receive the contact information, call the Originator and ask them for additional information on the payment. 

The NACHA Operating Rules state that the name in the Company Name field of the healthcare EFT standard “must contain the name of the Health Plan originating the Entry, or, where an organization is self-insured, the name of the organization’s third-party administrator that is recognized by the Healthcare Provider and to which the Healthcare Provider submits its claims.”  If the Company Name field is populated with something other than as defined above, the RDFI can file a Report of Possible ACH Rules Violation with NACHA.  NACHA will work with the ODFI to get the information in the Company Name field to comply with the NACHA Operating Rules.