HP Policy and Procedures Missing or Late EFT
December 9, 2013
The federally mandated CORE requirements for the Phase III CORE EFT & ERA Operating Rule Set specify that a health plan must release for transmission to the healthcare provider the v5010 X12 835 (ERA) corresponding to the Healthcare EFT Standards:
- No sooner than three business days based on the time zone of the health plan prior to the CCD+ Effective Entry Date
- No later than three business days after the CCD+ Effective Entry Date.
The CCD+ Effective Entry Date is a valid banking day. NOTE: Provider must contact its financial institution to arrange for the delivery of the CORE-required Minimum CCD+ data elements needed for reassociation of the payment to the ERA.
The following process should be followed by providers when researching and resolving late or missing EFTs. Late or missing is defined as a maximum elapsed time of four business days following the receipt of the ERA.
- Provider should first contact their bank to inquire about the EFT transaction.
- If the provider’s bank cannot trace the EFT, the provider should have available their provider id and the following data from the corresponding ERA: the EFT effective date, EFT payment amount, and the TRN segment information, then call HP Administrative Services at 1-405-416-1800 or toll-free 1-800-782-5218 to request that HP research it. TDD users call 1-405-416-1525 or toll-free 1-800-941-2160.
- Customer Service will first verify the bank account number and the ABA routing number that the claim payment was sent to with the provider
- If the numbers do not match, HP Agents will, after verifying that the claim has been paid to the correct practice location as billed;
- Send the provider the appropriate EFT Enrollment Form (If Out-of-Network).
- Or provide the web address where the forms are available (If In-Network).
- If the numbers match, HP Agents will;
- After verifying that the claim has been paid to the correct practice location as billed; take the provider’s name, provider id, contact information, EFT effective date, EFT payment amount, and the TRN segment information from the ERA and submit a request to research/resolve the missing EFT.
- Upon receiving the resolution from the technical team, call the provider back with our findings or a status (Target: within 2 business days).