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NACHA Paves the Way for $4 Billion in Savings with New Electronic Health Care Claims Payments

Posted on Nov 29, 2012

NACHA Operating Rules have been expanded to include standards for fully electronic health care payments using the ACH network.  The new Health Care EFT Standard allows health plans to use the ACH network for paying providers with a special format that sets the standard for “reassociation” of the electronic remittance advices (ERAs).  This strategy of separating the payment from the explanation of benefits (EOBs) or remittance advices keeps the ACH payment format simple and easy to adopt for all financial institutions.  The real question is how simple will it be for health care providers to reconcile the payments with the EOBs.

The NACHA rule sets the standards for using the CCD+ format for health care payments in a manner that is easily identifiable by health care provides.  In addition, the new format requires the inclusion of the reassociation number to link the payment to the remittance advice or EOB.  This process should eliminate the mountains of paper out of the health care payments process, which is a substantial advancement over the current process where only 33% of payments are made electronically.  However, health care providers are typically focused on providing great care for their patients and not on adopting new technology for payments and accounting. 

The new rule goes into effect on September 20, 2013, so financial institutions, health care plans and health care providers have time to get the word out and prepare for the change.  When fully implemented, this new rule is poised to save between $3.1 and $4.5 billion over the next 10 years, according to the NACHA press release.  If the banks, providers and insurance companies, or other health care plans can address this opportunity with a spirit of collaboration these cost savings estimates are likely to be twice the reported estimates.

More information can be found on the NACHA Healthcare Payments Resource Site at https://healthcare.nacha.org/.