Electronic Remittance Advice (ERA) - (Rev. 5, 08-30-02)

170 - Electronic Remittance Advice (ERA) - (Rev. 5, 08-30-02) A1-1431, B1-4431 The contractor shall accommodate provider requests to receive hardcopy checks or electronic payments with ERAs. Providers have the option to receive remittance information on paper or electronically. Providers who elect EFT are not required to receive ERAs. The contractor shall furnish ERAs to providers using the following criteria: A. Standard Format Requirement In lieu of the traditional method of sending hardcopy remittance advices and checks to providers, effective October 1, 1992, the contractor shall transmit, over wire only, the ANSI X12.835, Health Care Claim Payment/Advice (ANSI-835) to a requesting provider or to a requesting provider's billing service. The ANSI-835 is the only electronic remittance option available as of this date. If the contractor has any technical questions on formats or electronic remittance transmission requirements, it should contact its RO. B. Privacy Act Compliance Unless otherwise directed by CO, the contractor shall ensure that remittance information is transmitted to providers or their authorized billing agents either directly, through a Value Added network, or as authorized by a provider, to a bank that is capable of receiving ERA data and agrees to safeguard the data. C. Reconciliation Requirement Prior to entering into an electronic payment arrangement with a provider, the contractor shall ensure that its providers are able to reconcile their accounting records using the ANSI-835 remittance advice. Once this determination is made, it shall provide telephone support during normal business hours and allow for an initial reconciliation period of up to 30 days during which it will produce both paper and electronic remittances. After this 30-day phase-in period, it shall eliminate paper remittances for these providers. D. Standard Format Reference See the Claims Processing Manual, Chapter 22 - Remittance Notice to Providers, for information and additional requirements concerning the standard remittance advice format.