Medical eBilling

ACA - EFT & ERA Operating Rules

CAQH CORE 350 – Health Care Claim Payment/Advice (835) Infrastructure Rule

CORE Rule Version for Connectivity

Phase II CORE 270 Connectivity Rule Version 2.2.0.

Enrollment of the CORE 270 Connectivity (Safe Harbor) will require Enrollee to agree to Safe Harbor Terms of Use, during ERA Enrollment.

ERA File Retrieval Instructions

ERA File Retrieval

ERA (835) files are available for retrieval via the Safe Harbor Method of Retrieval for 90 days from the date they are created. Each file retrieval request will result in a single file response if a file is available for the sender of the request for the date requested. If no file is available for the date requested, the response will contain an Error Code of “No File Found” and an Error Message of “No File for date requested available”.

Files are named with the following naming convention. The first component of the file name is your receiver ID, the second component is the date of the file you are requesting, and the third component is STATE FARM’s identifier followed by the type of file it is.

DEG 7, Preference for Aggregation of Remittance Data is where obtain your preference for your receiver ID.

1112223334_20130510_SFCORE.835

The following request would retrieve the above file.

<soapenv:Body>
<ns1:COREEnvelopeBatchResultsRetrievalRequest
xmlns:ns1="http://www.caqh.org/SOAP/WSDL/CORERule2.2.0.xsd">
<PayloadType>X12_005010_Request_Batch_Results_835</PayloadType>
<ProcessingMode>Batch</ProcessingMode>
<PayloadID>f81d4fae-7dec-11d0-a765-00a0c91e6bf6</PayloadID>
<TimeStamp>2013-05-10T10:20:34Z</TimeStamp>
<SenderID>1112223334</SenderID>
<ReceiverID>SFCORE</ReceiverID>
<CORERuleVersion>2.2.0</CORERuleVersion>
</ns1:COREEnvelopeBatchResultsRetrievalRequest>
</soapenv:Body>

Note: Normal processing will result in one file per Business day when remits were processed. However, we are aware that an anomaly to our processing could result in a second file being created for a given Business day. If this occurs you will be contacted and instructions will be provided on how to retrieve this exception file.

Error Handling

If the username and/or password included in the request are not valid an HTTP 403 error response will be returned.

Envelope Processing Status and Error Codes are handled per section 4.3.3.2 of CORE Phase II 270 rule.

Dual Delivery of v5010 X12 835 and Proprietary Paper Claim Remittance Advices

Once enrolled in ERA, you will receive dual delivery of the paper remittance, during the first 31 days and three payments, along with the ERA. Paper remittance will discontinue one the timeframes are met.

Providers currently enrolled in ERA, who sign up for electronic enrollment, will receive Dual Delivery.

Enrollee will have the option to opt out of Dual Delivery. Located on the ERA and EFT Enrollment page, a link to cancel Dual Delivery will be available.

CAQH CORE 360 – Uniform Use of Claim Adjustment Reason Codes and Remittance Advice Remark Codes (835) Rule

Uniform Use of Codes

State Farm – Health has aligned our internal codes to correspond to the scenarios and code list specified by CORE.

CAQH CORE 370 – EFT & ERA Reassociation (CCD+/835) Rule
Receipt of the CORE-required Minimum CCD+ Data Required for Reassociation

Enrollee (Healthcare provider) will need to contact its financial institution to arrange for the delivery of the CORE-required Minimum CCD+ Data Elements necessary for successful reassociation of the EFT payment with the ERA remittance advice.

CORE-required Minimum CCD+ Data and corresponding v5010 X12 835 Data Elements

Resolving Late/Missing EFT and ERA Transactions

When an ERA or EFT is late/missing (four business days following the receipt of either the ERA or EFT) email HOME HLTH-MEDICALPROVIDER with your TIN, NPI, Method of Retrieval.

• Missing ERA - please include the payment number (#########GH####)
• Missing EFT - please include the TRN02 (EFT Trace Number) and, if available, the 2100 Other Claim Related Identification (this is our Bill ID)

CAQH CORE 380 – EFT Enrollment Data Rule & CAQH CORE 382 – ERA Enrollment Data Rules

ERA enrollment “only” is allowed.

EFT enrollment “only” is NOT allowed.

ERA enrollment is required prior to EFT enrollment.

When choosing your Method of Retrieval from State Farm – Health, (Emdeon, PNC Bank, UHIN, CORE Connectivity Safe Harbor), it is your responsibility to confirm your ability to receive your ERA through one of these connections.

EFT and ERA electronic enrollment applications are located on a secured B2B site. Assess to the secure B2B site starts with completion of the Contact Us form.

EFT & ERA Enrollment Instructions