Healthcare Payments Resources

 

Healthcare Administrative Technology Association (HATA) hata-assn.org

American Medical Association (AMA) – ama-assn.org

(Note:  Users must establish a free account to access AMA resources. By creating an account, you are not becoming an AMA member.)

AMA’s ERA Toolkit (www.ama-assn.org/go/era) provides a wealth of information for physicians in all stages of ERA implementation – from practices just beginning to consider ERA adoption to those who have already adopted ERA and are looking for ways to maximize automation and efficiency. Toolkit sections include:

  • Getting started with ERA provides a basic overview of the ERA and its content, describes the advantages of automating remittance processing and offers tips for ERA enrollment. It also describes the standardized code sets used in the ERA by all payers and what they mean to the practice. 
  • Critical conversations with trading partners about ERA provides questions to ask health plans, clearinghouses and practice management system vendors about their ERA handling and capabilities and describes how other stakeholders impact practices receiving the ERA.
  • ERA processing tips offers ERA processing flows and tips for practices, as well as information on handling overpayment recovery and non-claim-related adjustments in an automated fashion. The section also discusses the advantages of implementing the ERA with standard electronic funds transfer.

AMA’s EFT Toolkit (www.ama-assn.org/go/eft) offers support to providers in implementing electronic payments. Toolkit resources include:

  • Getting started: Accepting EFT payments in the physician practice
  • Key questions to ask your vendors before signing an EFT agreement
  • Know your rights and make ACH EFT work for your practice
  • The effect of health plan virtual credit card payments on physician practices

CAQH CORE – caqh.org

 Provider Resources

 Implementation Resources

 Rule Maintenance

Centers for Medicare & Medicaid Services – CMS.gov

Provider General Info on Operating Rules:

NACHA – healthcare.nacha.org

Healthcare Payments Resources Website

  • Provides a repository of information on a wide variety of topics for both financial institutions and the healthcare industry. Includes links to many other resources, as well as customized information to help “translate” concepts from one industry to the other (FAQs, reports, presentations) http://healthcare.nacha.org

Healthcare EFT Standard Information

  • Located within the healthcare industry tab of the above website, specific information can be found on the healthcare EFT standard.
  • http://healthcare.nacha.org

Healthcare Payments Resource Guide

  • Publication designed to help financial institutions in implementing healthcare solutions.  It give the reader a basic understanding of the complexities of the healthcare industry, identify key terms, review recent healthcare legislation, and discuss potential impacts on the financial services industry.
  • Order from the NACHA eStore “Healthcare Payments” section:  www.nacha.org/estore


Healthcare ePayments Newsletter

  • Newsletter for healthcare and financial services industry.  Must register to receive the free newsletter at  listrequest@nacha.org

ACH Primer for Healthcare Payments

  • A guide to understanding EFT payment processing.  Introduces the healthcare industry to the Automated Clearing House (ACH) Network, explains ACH transaction flow and applications, and includes two “next steps checklists,” one each for origination and receipt (free pdf publication) https://healthcare.nacha.org/ACHprimer

 Healthcare Case Studies

  • Case studies on the benefits of the healthcare EFT standard and ERA representing three different provider segments; a micro practice, a mid-size physician’s group, and a large hospital chain https://healthcare.nacha.org/providerresources

Optum - Optum.com

Provider general info:

Enrollment link:

TransFirst – cardpaymentadvocates.com 

TransFirst Healthcare Payments at the Point of Care: 

http://www.cardpaymentadvocates.com/#!healthcare-payment-challenges-slideshow/m3h3a  

 

Workgroup for Electronic Data Interchange (WEDI) - wedi.org

 WEDI EFT Subworkgroup:

WEDI 835 Subworkgroup:

WEDI Knowledge Center

Reassociating Healthcare Payments:  White Paper

 Reassociating your ERA and EFT Files (Webinar)

 The Theory of Reassociation

 http://www.wedi.org/forms/uploadFiles/5B3570000018F.toc.FebTownHall.pdf#search=%22era%22

 EFT Relationship to the 835:  Issue Brief

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