On January 10, the Department of Health and Human Services (HHS) issued interim final regulations regarding the standards applicable to electronic funds transfers (EFTs) made by health plans to health care providers. The regulations were prompted by Section 1104(b)(2)(A) of the Patient Protection and Affordance Care Act, which amended the earlier Health Insurance Portability and Accountability Act (HIPAA) by adding EFTs to the list of transactions for which HHS must adopt a standard under HIPAA. The goal of the new regulation is to make EFTs a more efficient method for the receipt of health claim payments. Comments regarding the regulations are due before March 12. Compliance will be required effective January 1, 2014.
The new regulations adopt two standards for health plans which transmit health claim payments to providers using EFTs. Specifically, the standards include (a) a format for when a health plan initiates or authorizes an EFT with its bank; and (b) specific information that must be contained in the EFT. Each EFT must include two specific parts. First, it must contain the EFT payment/processing information, and second, adjustments to the claim charges in an attached "remittance advice" notice, so that any adjustments to the payment are clear and explained. In the event that the remittance notice and the payment arrive at different times (which causes confusion and waste in matching up such payments and notices), the EFT regulations require the use of a tracking number so that the notice and payment can be easily and properly correlated.
The Interim Final Rule may be accessed here.