October 28, 2013

EFT and ERA (835) Operating Rules Update

On January 1, 2014, the EFT and ERA Operating Rules mandated by CMS as part of the Affordable Care Act will be implemented.  This implementation is an industry wide change.

• Beginning January 1, 2014, trading partners enrolled to receive the ERA (835), will no longer receive a paper remittance.
  • To determine if you are enrolled to receive ERAs, please check your trading partner mailbox or your clearinghouse to see if you are receiving 835 transactions.
• The rule requires the TRN02 (Reassociation Trace Number), in the 835 transaction, match the Trace Number in the EFT.
  • Trading partners receiving an 835 transaction should contact their software vendor to determine if this will impact automated posting, as payers may make changes to the TRN02 to meet this requirement.
• New ERA (835) Enrollment forms will be made available in late December 2013.
  • Providers currently enrolled for the 835 will not need to re-enroll.
• New procedures for reporting late or missing ERAs will be included in the new 835 enrollment instructions.

Some of the benefits you will see:

• To ease the burden of matching the ERA details to the EFT payment, the Check or EFT Trace Number in the ERA (835) will match the EFT Trace Number.
• To insure prompt delivery, the EFT and ERA must be issued within 3 business days of each other.
• All payers are required to use a standardized format for EFT and ERA enrollments, making the enrollment process easier for providers.

To learn more about how payers will handle other EFT and ERA Operating Rules, please contact the payer.