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September 2013: Healthcare Payments via ACH

On September 20th, changes to the NACHA Operating Rules related to Healthcare Payments via ACH go into effect. These changes are an integral part of the implementation of healthcare industry standards mandated by the Patient Protection and Affordable Care Act (ACA) that carry a January 1, 2014 compliance deadline.

Specifically, the Rule requires health plans to identify clearly the CCD entries that are Health Care EFT claim payments to providers through the use of the specific identifier "HCCLAIMPMT" as the Entry Description of the ACH transactions. For a CCD Entry that contains the healthcare indicator, the health plan must include an addenda record that contains the ASC X12 Version 5010 835 TRN (Reassociation Trace Number) data segment, and to identify itself in the transaction by its name as it would be known to the provider. The TRN data segment, along with additional information contained with the Entry, is required by healthcare providers to reassociate the Health Care EFT Transaction with the electronic remittance advice (ERA) that is transmitted separately.

The Rule also requires the RDFI to provide, either automatically, or upon request, the information contained within the Payment Related Information field of the addenda record no later than the opening of business on the second banking day following the Settlement Date of the Entry. This Rule requires the RDFI to offer to the healthcare provider an option to receive or access the Payment Related Information via a secure and electronic means.

The Rule also provides for the use of a second data segment terminator, the tilde ( ~ ), to any data segments carried in the Addenda Record of the CCD Entry.

Health plans may begin using the transaction identification and formatting standards within this Rule earlier than the effective date; use of the new standards should not cause any processing problems for Receivers. Similarly, RDFIs that do not currently offer an electronic option for the delivery or provision of payment related information may do so as soon as they are ready.

For additional information regarding this Rule change, or to request a copy or access to the latest ACH Rules from PNC, please contact your Treasury Management representative to request an access code to 'achrulesonline.org'.

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