Changes to EFT and ERA transactions
Review industry mandates in the Affordable Care Act.
Section 1104 of the Affordable Care Act includes an industry mandate for the use of operating rules for the handling of EFT and ERA transactions.
The operating rules for EFT require the adoption of the CCD+ and the X12 835 TR3 TRN Segment as the health care EFT standard. These standards must be used for electronic claims payment initiation by all PBMs that conduct health care EFT.
The ERA must be provided in the v5010 X12 835 structure.
Industry research groups identified a significant issue for pharmacies when matching the EFT to the ERA because they both travel separately to the pharmacy. The reassociation of the EFT to the ERA is being solved by the inclusion of a reassociation trace number.
The same reassociation trace number will appear in designated fields on the EFT and ERA file. This table displays the minimum data elements from the CCD+ (EFT) for successful reassociation of the EFT payment with the corresponding v5010 X12 835 (ERA).
Pharmacies must contact their financial institution to arrange for the delivery of the CORE-required Minimum CCD+ Data Elements necessary for the successful reassociation of the EFT payment with the ERA remittance.
Once the financial institution delivers the data elements above, pharmacies will be able to easily match the reassociation trace number provided in the EFT to the reassociation trace number in the ERA.