Payment and remittance advice processing are faster when a provider receives payment via Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) instead of via paper check and corresponding paper remittance advice. The CAQH Index estimates the proportion of these transactions conducted electronically. Several key barriers exist to achieving rapid, industry-wide adoption of EFT and ERA including:
- Non-uniform and inconsistent use of the 1000+ Claims Adjustment Reason Codes (CARCs) and Remittance Advice Remark Codes (RARCs)
- Inconsistent data elements required by health plans for provider EFT and ERA enrollment
- Inability of providers to specify to the health plan how payments should be made, i.e., by National Provider Identifier (NPI) or Tax ID
- Challenges to provider reassociation of the EFT and ERA due to non-matching trace numbers and extensive time delays between receipt of the EFT and ERA
The CAQH CORE Payment & Remittance Operating Rules address these challenges by requiring:
rule type | rules | key rule requirements |
---|---|---|
data content | Uniform Use of CARCs and RARCs Rule |
|
infrastructure | Health Care Claim Payment/ Advice Infrastructure Rule |
|
infrastructure | EFT and ERA Reassociation Rule |
|
infrastructure | EFT Enrollment Data Rule and ERA Enrollment Data Rule |
|
*CMS-0028-IFC excludes requirements pertaining to acknowledgements