CMS: Health Plans Can't Delay, Reject Electronic Payment Requests

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CMS has encouraged providers to enact a new electronic payment standard for receiving reimbursement from health plans.

According to an FAQ answer posted on the CMS website, providers can request that health plans conduct electronic funds transfers and remittance advice transactions through the Automated Clearing House Network — which is the standard format for EFT and ERA transactions under operating rules that took effect Jan. 1.

Health plans must comply with the HIPAA standard for these transactions. Furthermore, health plans can't delay or reject an EFT or ERA transaction through the ACH Network, and they cannot incentivize providers to use an alternate payment method. Health plans also can't adversely affect providers for using the EFT or ERA standard (for instance, by charging excessive fees).

Ultimately, CMS recommends providers carefully analyze their agreements with health plans, regardless of the payment method they choose.

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