All HIPAA covered entities, including providers, clearinghouses and payers, are required to comply with the Affordable Care Act (ACA) requirements to implement the CORE Phase III Operating Rules for two HIPAA transactions:
- Electronic Fund Transfer (EFT)
- Electronic Remittance Advice (ERA) (835).
Nebraska Medicaid is working toward incorporating these changes. The AS-EFT/ERA Project is being implemented in two Tracks.
Notifications to Providers
- Effective October 1, 2014, Medicaid providers who receive Electronic Funds Transfer (EFT) payments through MMIS must utilize the new MS-84 form for new provider enrollments or when making changes to existing provider enrollments. This form is to be used by providers to enroll for EFT payments and designate a bank account for the deposits. See Provider Bulletin No. 14-32 for details.
- Effective October 1, 2014, Medicaid providers enrolling to exchange EDI transactions must begin using the MS-85 and the MS-86 forms for new EDI enrollments or changes to existing EDI enrollments. See Provider Bulletin No. 14-30 for details.
- These new forms apply only to Medicaid providers who submit transactions and receive payment through the MMIS.
Track 1 (Operating Rules 350 Dual Delivery, 360, 370, 380, 382):
- Implemented June 18, 2014.
- Dual delivery of Remittance Advice (RA) will facilitate transition to electronic remits.
- New billing providers can elect to receive dual delivery (paper & electronic) as part of enrollment for the ERA (835).
- Temporary dual delivery during ERA implementation testing:
- All new billing providers and existing providers switching from paper to electronic delivery of remittance advice will receive both paper RAs and ERAs during ERA implementation testing.
- Temporary dual delivery will continue after the 835 is implemented until three payments are complete, if the provider requests upon enrollment.
- Uniform Use of Claims Adjustment Reason Codes (CARCs) and Remittance Advice Remark Codes (RARCs) will change.
- Medicaid CARCs/RARCs have been aligned to CORE-defined CARC and RARC combinations grouped by Business Scenario.
- Nebraska-specific business scenarios for 139 and 411 code combinations were created.
- Sending EFT and ERA reassociation data in CCD+ format becomes banking standard.
- Ensures providers can use trace numbers (EFT number) to tie payments to remittance.
- Providers need to contact their financial institutions to arrange for the delivery of the minimum CCD+ data elements necessary for reassociation.
- New enrollment forms for EFT (MS-84) and ERA (MS-86) were created to conform to standard data elements, flow and format of data collection required by CORE Operating Rules 380 and 382. See Provider Bulletin No. 14-28 for details.
- To align to these new forms, the Trading Partner Authorization became the MS-85 form and ERA enrollment was moved to MS-86.
- The processes for providers to follow to report a missing/late EFT or ERA are also published.
- The new forms and procedures apply only to Medicaid providers who submit transactions and receive payment through the MMIS.
Track 2 (Operating Rule 350 Connectivity):
- A vendor to implement these changes has been selected, with implementation later this year.
- Connectivity methods for the EFT and 835 transactions will be expanded.
- Companion Guide template will change.
There will be no change required for the current batch processing of the 835 ERA transaction.
To assist in delivery of information, a dedicated email address has been created for questions and answers specific to the Administrative Simplification projects. This email address is: DHHS.ACAEDIAdminSimp@Nebraska.gov
If you are not familiar with the CORE Phase III Operating Rules, they are available at no charge from the Council for Affordable Quality Healthcare (CAQH) Committee on Operating Rules for Information Exchange® (CORE) Web site at: http://www.caqh.org/ORMandate_EFT.php
Phase III Rules