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So it’s important to examine all options to reduce the rising healthcare reimbursement and administrative costs that healthcare payers are facing .Of the ever-increasing healthcare costs, how much is attributable to administrative and payment expenses?You can request new codes and revisions to existing codes at certain times each year.Select the "Change Request Form" option on the Washington Publishing Company web pages for CARCs or RARCs.
This collaboration between Nacha and the healthcare industry came about as a result of the Patient Protection and Affordable Care Act (ACA), which mandated identification of a healthcare EFT standard and the implementation of operating rules for all electronic healthcare transactions by January 1, 2014.Under HIPAA, all health plans, including Medicare, are required to use claims adjustment reason codes (CARCs) and remittance advice remark codes (RARCs) instead of property codes, to explain any adjustment in the claim payment.X12 is the recognized code set maintainer for the CARCs and RARCs.This mandate provides standards and guidelines to promote the migration of healthcare claim payments and explanation of payments (EOPs) from checks to EFTs and electronic remittance advices (ERAs). The ACA EFT Mandate states that a healthcare payer must be able to offer and support electronic claim payments through ACH transactions if the healthcare provider asks for it.In addition, the mandate specifies that the Electronic Data Interchange (EDI) 835 ERA format must also be sent in support of that payment.
For more guidance on standardized EFT/ERA enrollment data elements please refer to the CAQH CORE operating rules found at Phase III EFT and ERA Operating Rules.