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Get EFT processes in line for HIPAA compliance

While most healthcare providers think of clinical data when it comes to crafting HIPAA compliance strategies, Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) processes are affected by updated HIPAA laws, too.

The Workgroup for Electronic Data Interchange (WEDI) recruited 15 healthcare professionals to pen its latest white paper, “EFT and ERA Enrollment Process,” a tool for health plans, providers and clearinghouses. The guide outlines EFT and ERA regulations in great detail, citing specific examples for industry leaders to follow as they implement process changes under HIPAA.

The Affordable Care Act of 2010 requires Medicare-eligible providers to identify an EFT standard, develop EFT and ERA operating rules and creating usage requirements of EFT  by 2014. This, according to the authors, effectively mandates them for all HIPAA-covered entities.

WEDI’s EFT Subworkgroup compiled information to clarify the current EFT and ERA standards and proposed operating rules. They offer best practices for implementing and utilizing the requirements. A few notable standards from the process include:

  • There is a maximum set of allowable data elements that can be included on an EFT enrollment form. What’s more, there’s a specific list of “controlled vocabulary” for them.
  • The EFT Enrollment Rule also includes a requirement that the paper-based forms and electronic screens follow a “master template” that define format, flow, field names and descriptions as well as the overall data set.
  • The health plan must provide written instructions for how to complete the form, exact address or email address for delivery of the paper form (if applicable) and contact information (including telephone number and email address) at the health plan.
  • Payers that provide EFT today have an EFT Enrollment form they use to enroll providers for EFT. It can be in paper form, a Web template or other electronic format. Once the provider completes the information and submits it to the payer, the payer will then validate the information to ensure that the submitter of the form is a valid provider and is eligible for receiving EFT payments.
  • The ERA Enrollment Rule specifies that all health plans and their respective agents must implement and offer any trading partner (e.g., a healthcare provider) an electronic method and process for collecting the data set.
  • Some payers also require that the submitter provide a copy of a voided check or a bank letter that can be used to validate the account information. They may also require the signature of the financial officer of the organization to ensure the payer is being properly authorized by the provider to send EFT transactions to that account.
  • The enrollment process for ERA involves different information than what is needed for EFT;  there may be more systems involved in setting up the process for a provider to receive the ERA.