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Episode 158: Slow and Steady, How Health Care is Progressing Toward Value Based Care. Lynn Carroll, HSBlox

December 16, 2022

The opportunities for improved efficiency and cost-savings associated with industry adoption of the Automated Clearing House (ACH) Electronic Funds Transfer (EFT) transaction are well established. However, despite having a national standard and supporting operating rules, compared to some other transactions ACH EFT is underutilized by the industry, with the most recent 2021 CAQH Index® reporting that 76% of medical claim and only 16% of dental claim payments are made via ACH EFT.

 

The purpose of this principles document is to establish a consensus-driven set of principles that each impacted stakeholder could review and adopt to drive adoption of ACH EFT while at the same time establishing guidelines for the use of alternative payment options.

 

This document contains three main sections:

  1. A general introduction to issues related to electronic payments (epayments), including applicable definitions, identification of barriers to provider adoption of epayments, and the return on investment associated with ACH EFT, especially when coupled with electronic remittance advice (ERA).
  2. An outline of the various epayments federal mandates, including the operating rules developed by CAQH CORE.
  3. Several recommended guiding principles to which all impacted stakeholders are encouraged to adhere regarding the implementation and ongoing use of epayments.

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