HIPAA FAQs Elaborate on EFT/ERA Transaction Requirements

HHS’s Nationwide Requirements Group (NSG) has launched FAQs to elaborate on points mentioned in Steerage Letter 2022-04, issued in March 2022, which addressed the HIPAA requirements for well being care digital funds transfers (EFT) and digital remittance recommendation (ERA) transactions between well being plans and well being care suppliers (see our Checkpoint article). As background, NSG administers HHS’s compliance overview program to make sure that lined entities adhere to the HIPAA administrative simplification guidelines for digital well being care transactions. NSG’s steerage letters will not be legally binding however clarify NSG’s interpretations of HIPAA’s administrative simplification provisions. NSG’s FAQs present transient operational or technical data.

According to the steerage letter, the FAQs reiterate that well being plans can’t compel well being care suppliers to just accept digital bank card funds for providers and should adjust to a supplier’s request to make use of adopted requirements for EFT funds by means of the automated clearing home (ACH) community or for ERA transactions. The FAQs additionally emphasize {that a} supplier needn’t be a part of a well being plan’s community, or in any other case affiliated with a well being plan, to obtain EFT and ERA transactions utilizing the adopted requirements. As famous within the steerage letter, HIPAA doesn’t present exceptions to the requirement that well being plans conduct a transaction as a normal transaction when requested by a supplier. Nonetheless, a supplier should enroll to conduct EFT and ERA transactions with every well being plan that the supplier payments. NSG cautions that the steerage letter doesn’t communicate as to if charging charges to conduct commonplace transactions, in and of itself, violates the HIPAA necessities—the query is whether or not the well being plan’s actions “adversely have an effect on” a normal transaction. Furthermore, though well being plans should adhere to the transaction requirements in response to supplier requests, plans needn’t conform to a supplier’s request to ship funds by means of different means (e.g., by way of paper test). Additionally, a well being plan is just not prohibited from providing to course of an ERA transaction in a nonstandard format on the supplier’s behalf, however the supplier could reject that supply and request supply in the usual format. The FAQs clarify that suppliers could use the ASETT software to file complaints towards well being plans that fail to adjust to a request to ship EFT and ERA transactions utilizing the adopted requirements.

EBIA Remark: Though NSG has an enforcement focus, the FAQs word that NSG is just not approved to reimburse suppliers for prices they incur as a result of a well being plan’s noncompliance with HIPAA necessities. Moderately, any civil financial penalty is deposited with the USA Treasury. That is one other space of distinction with enforcement of the privateness, safety, and breach notification provisions, which require HHS to ascertain a technique to distribute a share of civil financial penalties or settlement quantities to people harmed by noncompliance (see our Checkpoint article). Coated entities and enterprise associates focused on avoiding the fee and inconvenience of enforcement actions ought to overview the FAQs and related assets, together with reality sheets (see our Checkpoint article). For extra data, see EBIA’s HIPAA Portability, Privateness & Safety handbook at Sections XX (“Enforcement of Privateness, Safety, and EDI Guidelines”) and XXXII (“Digital Transactions and Code Units”).

Contributing Editors: EBIA Workers.