In an industry that is steadily transitioning into paperless processes, payers are no longer able to avoid the digital movement. Payers are now required to support both electronic remittance advice (ERA) and electronic funds transfer (EFT) capabilities. This means that payers must assess how to implement such capabilities, whether that be through the support of resources from within an organization or through the guidance of a third-party vendor.
Either way, when it comes to figuring out how to best deliver ERA/EFT, taking these factors into consideration will prove essential in moving forward:
1. Adoption Plan
While supporting ERA/EFT capabilities is one thing, being able to sell such a service to providers is another. Efforts must be made to reach out to providers to educate them on the benefits of employing electronic processes, as well as guide them through the enrollment process from start to finish. Making a provider adoption plan will surely support this initial stage.
2. Monitoring Security and Controls
Given the instantaneous nature of ERA/EFT, payment transactions are likely to occur daily, and must therefore be monitored daily, as well. Setting up systems to monitor all levels of activity will be imperative in ensuring financial security measures are maintained. Controls must also be in place to help providers safely, efficiently, and securely update their account changes when necessary.
3. Compliance Standards
Along with mandates that now require payers to support ERA/EFT capabilities, payers must also adhere to new operating rules in accordance with standards set forth by CAQH CORE on healthcare information exchange. Avoiding penalties means being aware of these standards and taking efforts to ensure compliance.
4. Third-Party Value and Risks
Regardless of whether or not a payer decides to access internal resources to support ERA/EFT, they will need to access outside financial networks and accounts to be able to set up electronic transfers. Third-party vendors are not only helpful in supporting these systems, but they also prove particularly beneficial when it comes to ERA/EFT solutions. Whenever a third-party vendor is involved in payer processes, it is important for payers to know who they are working with and what they are accountable for when it comes to monitoring payment activity for providers, so as to minimize risks and maintain credibility.
5. Plan and Implement
In order to successfully implement ERA/EFT, payers must create a comprehensive implementation plan, so as to assess resources, responsibilities, challenges, and requirements beforehand. Testing out the implementation plan with a pilot provider may also prove beneficial.
So regardless of which implementation model is used—be that internal services or a third-party vendor—taking into consideration these five factors will be essential to understanding the scope of work that comes with achieving ERA/EFT capabilities that support the payer to provider relationship.