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Knowledge Center

Episode 162: Workgroup Voices, The Inner Workings of Prior Authorization

February 2, 2024

The enrollment process for EFT and ERA varies widely throughout the industry today.  This document was previously published in 2013 and has been updated to include an overview of enrollment processes for ERA and EFT, along with best practices and model enrollment forms. The paper includes an overview of the CAQH CORE Payment and Remittance Operating Rules that address the EFT and ERA enrollment process for both paper and electronic enrollments and requirements for health plans, providers, and clearinghouses. This document also will include information provided by the survey conducted by The Cooperative Exchange in 2021 to further identify ongoing issues with ERA and EFT enrollments.

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