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HIPAA Simplified
ERA / EFT
The ASC X12N Health Care Claim Payment/Advice (835) transaction, also known as the Electronic Remittance Advice (ERA) is used by health plans to communicate details concerning the adjudication of a claim. Information provided by the ERA includes:
- Amounts paid
- Reasons for adjustments or denials
- Patient financial liability that has been applied
- Bundling or splitting of payments
- Payment method, such as check, electronic funds transfer
When payment is made by electronic funds transfer (EFT), the EFT and the ERA are almost always sent through different networks and are often received by healthcare providers at different times.
A common method for transmitting an EFT is via the Automated Clearing House (ACH) network, utilizing the NACHA Cash Concentration/Disbursement plus Addenda (CCD+) format. Placement of the TRN segment of the ASC X12N Health Care Claim Payment/Advice into the Addenda record of the CCD+ allows the provider to re-associate the payment with the ERA.
Standards
Current Versions
Electronic Remittance Advice (ERA)
The current industry version of the ASC X12N Health Care Claim Payment/Advice (835) is 5010. This version was adopted under HIPAA to replace version 4010 on January 16, 2009.
The Technical Report Type 3 ASC X12N/005010X221A1 Health Care Claim Payment/Advice (835) can be purchased at www.x12.org/products.
Electronic Funds Transfer (EFT)
The standard for Healthcare EFT transactions is the Cash Concentration/Disbursement plus Addenda (CCD+) implementation specifications from the 2011 National Automated Clearing House Association (NACHA) Operating Rules and Guidelines.
On January 10, 2012, the U.S. Department of Health & Human Services issued the Administrative Simplification: Adoption of Standards for Health Care Electronic Funds Transfers (EFTs) and Remittance Advice; Interim Final Rule, which established healthcare EFT standards for claim payments initiated over the Automated Clearing House (ACH) network. The effective date of the regulation was January 1, 2014.
Next Published Versions
Electronic Remittance Advice (ERA)
The next published version of the ASC X12N Health Care Claim Payment/Advice (835) will be 7030™. This version can be purchased at www.x12.org/products.
See the Change Healthcare Regulatory and Standards Quarterly Update for details concerning the X12 publication schedule.
Electronic Funds Transfer (EFT)
When the electronic funds transfer, or EFT, is the electronic message used by health plans to order a financial institution to electronically transfer funds to a provider’s account to pay for health care services. An EFT includes information such as:
- Amount being paid
- Name and identification of the payer and payee
- Bank accounts of the payer and payee
- Routing numbers
- Date of payment
For additional information, see https://www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/Transactions/HealthCarePaymentandRemittanceAdviceandElectronicFundsTransfer.
Anticipated Regulation
Immediately following publication of 7030TM, X12 will promote the 835 TR3 to version 8010 TM and is expected to recommend the 8010 TM version to CMS for adoption under HIPAA.
Note: Following the publication of version 8010, X12 will move to an annual release cycle of TR3s. See https://x12.org/about/arc-faq for more information.
7030TM and 8010TM are trademarks of X12. All rights reserved.