Insurers must use standardized electronic payments

Health insurers must use standardized electronic funds transfers (EFT) to send information to their banks and other businesses to pay claims electronically under a new rule issued Thursday by the Department of Health & Human Services (HHS).

The interim final rule, which will be published in the Federal Register Jan. 10, brings insurers into the 21st century. U.S. businesses reportedly make an average of 43 percent of payments to other businesses through EFTs, but health insurers only make 15 percent of their payments to providers through EFTs, according to LifeHealthPro.

The new rule also requires remittance advice, a notice of payment in which the insurer must explain why it is paying an amount different from the amount a provider billed. It also includes tracking numbers so doctors can more easily match up the payments with their corresponding bills, reports DOTmed News.

Insurers can submit comments to HHS within 60 days of the official publication date, however, HHS warned they shouldn't blame problems complying with the EFT standards on banks, LifeHealthPro reports. Instead, agency officials recommended insurers educate their banks about the healthcare EFT standards. "The health care EFT standards adopted herein apply to health plans, and health plans are ultimately responsible for ensuring compliance with the standards regardless of whether a health plan puts the data into standard format itself or uses a financial institution to do so," HHS said.

The rule could cost insurers $4,000 to $6,000 each to installing necessary software and train staff, notes LifeHealthPro. But HHS estimates that the entire healthcare industry could save more than $16 billion during the next 10 years because the electronic standards will help eliminate inefficient manual processes and will reduce costs.

To learn more:
- read the HHS press release and interim final rule
- check out the LifeHealthPro article
- see the DOTmed News article