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 pleased to announce that it has received a CAQH CORE® health plan certification seal and exchanges electronic administrative data in compliance with the CORE rules.
CAQH CORE®, the CORE-certification/Endorser Seals and logo are registered trademarks of CAQH® Copyright 2010, Council For Affordable Quality Healthcare®. All rights reserved.
Track 1 (Operating Rules 350 Dual Delivery, 360, 370, 380, 382):
- Implemented June 18, 2014. See Provider Bulletin No. 14-24 for more details.
- 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 the following Provider Bulletin Numbers: 14-28, 14-30 and 14-32 for details.
- Medicaid providers who receive Electronic Funds Transfer (EFT) payments through MMIS must utilize the MS-84 form for new provider enrollments or when making changes to existing provider enrollments.
- Medicaid providers enrolling to exchange EDI transactions must use the MS-85 and the MS-86 forms for new EDI enrollments or changes to existing EDI enrollments.
- 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):
- Implemented May 18, 2015. See Provider Bulletin No. 15-16 for more details.
- Connectivity methods for the 835 Electronic Remittance Advice (ERA) include the addition of HTTP/S.
- Trading Partners will have the option to receive the 835 batch transaction through HTTP/S, as well as the current SFTP connectivity method.
- Companion Guides follow the format/flow as defined by the CORE template and are posted on the EDI Submission Requirements (5010) web page: http://dhhs.ne.gov/medicaid/Pages/edireq-5010.aspx.
- A static IP address will be required by Trading Partners for each machine the Trading Partner uses for HTTP/S connectivity.
NOTE: There will be no change required for the current batch retrieval of the 835 transaction through SFTP or for the processing of other HIPAA X12 transactions.
IMPORTANT: Proprietary reports such as the Refund Report will not be available via HTTP/S. When requesting HTTP/S connectivity for the 835 transaction, Trading Partners will be (or will remain) enrolled for the 835 via SFTP in order to access the necessary proprietary reports.
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