Healthcare Payments, the ACH Network, and the NACHA Operating Rules – All the Details

Format: Live Webinar

Presenter: Donna K Olheiser, AAP

Event Date: 07/12/2023

Time: 3 pm ET | 2 pm CT | 1 pm MT | 12 pm PT

Duration: 90 minutes

Course Description:

In Sept 2013, the NACHA Operating Rules were implemented to allow us to identify and track healthcare payments via ACH and provide for the automatic reassociation of healthcare payments with payment information.

These Rules, in conjunction with the healthcare industry operating rules for EFT and electronic remittance advice (ERA), helped simplify the administrative process by healthcare providers and health plans. NACHA partners with the healthcare industry, using the NACHA Operating Rules and Guidelines to support the standardization of payments between health plans and providers. This adapted set of rules helped standardize healthcare electronic funds transfers (EFTs), which is critical to helping streamline the healthcare industry’s payments operation.

According to NACHA.org; By supporting the healthcare EFT standard, NACHA (the National ACH Association) helped:    

• Make EFT more efficient by leveraging the ACH Network and NACHA’s CCD+ (SEC Code and payment type) as the healthcare EFT standard.
• Reduce administrative costs for doctors and hospitals.
• Save an estimated 800,000 pounds of paper by replacing paper checks with electronic transfers.

In addition, NACHA defines a Healthcare EFT as an electronic funds transfer where the claim is deposited directly into a medical/dental provider’s bank account. By eliminating the need to take anything to the bank to be deposited and reducing the amount of staff time needed to process claim payments.

EFT claim payments are ideal for medical practices of any size, especially smaller ones where time and personnel are at a premium. Switching to ACH, or EFT, as it’s also known, gives practices the opportunity to save as much as 50% on claim payments.

By utilizing the ACH network for Healthcare payments, medical practices can save the hassle and added expense of writing and mailing a check. With ACH, businesses—including medical offices—can lower overall costs vs. other payment types. Now - that’s good business!

During this 90-minutes session, the trainer will walk you through the Rules surrounding Healthcare Payments in ACH, the basics of formatting, and how this process works from beginning to end. (from the health care plans paying the healthcare provider, to the healthcare provider know how to apply the payments received).  Very detailed information will be provided with examples of what this means and how this affects each party to the Healthcare Payments (CCD+) transaction in the ACH Network.  

 Learning Objectives:

At the completion of this educational activity, the learner will be able to:

• Identify the benefits of an ACH Healthcare Payment (CCD+)
• Describe the process of a Healthcare EFT from beginning to end
• Locate the details needed by the provider when receiving the ACH Healthcare payment in order to properly apply the payment
• Define the NACHA Operating Rules in conjunction with HIPAA that protect patient confidentiality by teaming with the healthcare industry when sending payments from healthcare plans to providers
• List details of the SEC (Standard Entry Class Code) CCD+ payment being used to transmit Healthcare Payments in the ACH Network

Areas Covered in the Session:

• How the ACH Network has helped many healthcare providers save money utilizing this payment system to receive benefit payments
• Statistics over the past few years identifying how the Healthcare Industry utilizes the ACH Network to transmit payments from the healthcare plan to healthcare providers
• Format details on the CCD+ ACH transaction used to send Healthcare Payments
• Discussion on HIPAA and the NACHA Operating Rules - working together to help the healthcare industry save money by using the ACH Network
• Details on how the ACH Network works while transmitting, processing and receiving payments related to Healthcare while meeting Healthcare Standards
• Live Q&A Session

Suggested Attendees:

• Healthcare Executives
• Healthcare Providers
• Physicians
• All Specialties Doctors
• Third-Party Services Providers (TPSP) who process payments for healthcare plan companies or healthcare providers
• Health Plan Companies
• Finance Manager and Officers
• Reimbursement Specialist and Staff
• Financial Institutions who have business accounts with healthcare providers
• Financial Institutions who have business accounts with healthcare plan companies      

About the Presenter:

Donna founded Dynamic Mastership, LLC in December 2014 to utilize her 24+ years of experience in the financial services industry, by sharing her passion for training financial institutions and organizations on the Rules and processes for electronic payments (with her specialty being ACH payments). She holds the Accredited ACH Professional (AAP) designation (achieved in 2004).

Donna’s experience before founding Dynamic Mastership includes 9 years serving as the Education Service Director at a Regional Payments Association (RPA), where she managed and facilitated the entire Education program for nearly 800 financial institution members. Prior to that, Donna spent 14 years with the Federal Reserve Bank of Minneapolis in various departments, where she started her training career as the Training and Development Specialist in FedACH Central Operations, Feb 2003.

Donna is a certified Master Trainer who continually uses her extensive knowledge, experience, enthusiasm, and passion for transferring payment processing details while using the adult learning theory is remarkable! Her training style has helped many payment professionals remain consistently informed of the NEW and ever-changing NACHA Operating Rules and explain how the Rules apply when performing daily operational tasks including complex return and exception processing. She incorporates scenarios and examples in her detailed training, so the Rules are easy to comprehend and apply to real-life day-to-day ACH processing. Donna’s ability to engage the learner through the entire training event helps the adult learner apply what they have learned during and after each training session.