Electronic Funds Transfer for Payments to Health Care Providers

Printer Friendly, PDF & Email
Type Standard Implementation/Specification Standards Process Maturity Implementation Maturity Adoption Level Federally required Cost Test Tool Availability
Implementation Specification
Final
Production
Rating 3
Yes
$
Yes
Limitations, Dependencies, and Preconditions for Consideration Applicable Security Patterns for Consideration
  • Widespread implementation of the Electronic Funds Transfer (EFT) transaction by providers may be somewhat constrained by unanticipated transaction fees and costs associated with new payment technologies (e.g. virtual credit cards)  imposed or used by third parties, vendors, clearinghouses, and health plans
  • File testing is done between the banks and their originators of the ACH files, between the banks and the ACH Operators and for the software vendors with the ACH Operators. Testing for a new originator is done with the bank before they originate their first file. Testing between the banks and the ACH Operators is done when there is a new application – currently a lot of testing is being done between the banks and the ACH Operators for Same Day ACH Debits (to be implemented in September 2017). If a bank changes ACH processing software or hires a third-party vendor, testing will be done between the bank and the ACH Operator.
  • Because only the current version of an ACH file format is allowed through the ACH Network, the originating bank reviews all files to make sure that the formatting is correct before they send the files to the ACH Operators. The ACH Operators also review all files to make sure that the mandatory fields within the ACH file are formatted correctly – if they are not the files are returned to the originating bank. Both the originating bank and the ACH Operators are looks at the files to make sure that the files are syntactically correct.
  • ACH Network is an electronic funds transfer system governed by the NACHA Operating Rules, which provides for interbank clearing of electronic entries for participating financial institutions.

Comments

Permalink

The Electronic Funds Transfer for Payments to Health Care Providers is applicable to all providers and not just those which bill professional or institution claims. Remove “Professionals and Institutions”.