UHIN STANDARDS COMMITTEE

Transcription

1 UHIN STANDARDS COMMITTEE Electronic Funds Transfer (EFT) and Automated Clearing House (ACH) Specification Version 2.1 Contents General... 1 Purpose... 1 Applicability... 1 Basic Concepts... 1 Detail... 2 Payer... 2 Provider/Biller Requirements... 2 ACH Specification... 2 History... 7 General The UHIN Electronic Funds Transfer (EFT) and Automated Clearing House (ACH) Specification is compatible with all HIPAA and Banking requirements. Purpose The purpose of this Specification is to inform UHIN subscribers of the requirements for providing an EFT transaction to providers (upon request) when doing the 835 Electronic Claim Payment transaction. Applicability This Specification applies to all UHIN payers and providers using the 835 transaction. Basic Concepts Within the 835 Electronic Claim Payment Advice, the CCD+ and the CTX are the only two types of EFT/ACH allowed when creating a compliant 835 under HIPAA. The CCD+ allows 80 characters of remittance advice data, enough to re-associate dollars and data when the dollars are sent electronically through the ACH and the data is sent on a separate path. The addenda record should contain a copy of the TRN segment.

2 The CTX format moves dollars and data through the ACH. The CTX can contain up to 9,999 addenda records of 80 characters each. The CTX encapsulates the complete 835 and all envelope segments. Detail Payer 1. Establish banking relationship with an EDI capable bank. 2. Establish communication methodology with the bank directly. 3. Develop mechanism in payer payment system to indicate if provider requests EFT payment or paper check payment. 4. During the payment generation process, create the data elements necessary to populate the ACH transaction as described below. 5. Obtain authorization form (See Exhibit X for UHIN Recommended Standard Form). 6. Update provider file maintenance to indicate EFT providers and Trading Partner information. 7. Conduct appropriate testing (often referred to as pre-note ) as required by the bank to validate setup and account information stored in file maintenance. 8. Create and send production ACH transaction to bank. Provider/Biller Requirements 1. Establish arrangements with financial institution. 2. Notify each payer of intent to use EFT, using the authorization form required by the payer. 3. Ensure a method is in place to reconcile the data and dollars. This method may reside inside the provider s accounts receivable/practice management system, or may require some other external software or process. 4. Download and manage/print all EFT reports, electronic remittance advice (835) and other transactions which come to the provider as supporting documentation for the ACH transaction. 5. Coordinate with the payer if an EFT transaction is received by the bank with no corresponding 835 data from the payer, or vice versa. ACH Specification FILE HEADER RECORD - Repeat 1 per file DATA PROVIDED FROM THE 835 ELEMENT TYPE DESCRIPTION SIZE Record Type N Use "1" 1 Priority Code N Use "01" 2 Immediate Destination N Routing and Transit Number of Originating DFI preceded by a space 10 BPR07 when BPR06=01

3 Immediate Origin N Usually the Tax ID of the entity sending this file preceded by a "1" 10 BPR10 Transmission/File Date DATE Date file was created - YYMMDD 6 Transmission/File Time TIME Time file was created - HHMM 4 File ID Modifier AN Use "A", "B", "C" etc. 1 Record Size N Block at 94 char use "094" 3 Blocking Factor N Use "10" 2 Format code N Use "1" 1 Immediate Destination Name AN Use "Bank Name" (1st Institution from Payer) 23 Immediate Origin Name AN Originating Company Name (Payer Name) 23 N102 Reference code AN Leave Blank 8 COMPANY BATCH HEADER RECORD - 1 per batch Record Type N Use "5" 1 Service Class Code N 220 = Credits 3 BPR03 Company Name AN Used to identify the source of the entity 16 N102 Company Discretionary AN Optional Use [May contain Batch ID/Trace 20 Data Number] Company Identification N Usually the Tax ID preceded by a "1" 10 BPR10 Standard Entry Class AN CCD (When BPR04= ACH then BPR05 = CCP) CCD+ is used when the data and dollars flow separately, CTX is used when the 835 data flows with the EFT data to the bank. Use of CTX is not used in UHIN as participants have access to UHIN systems to deliver/receive the 835 directly. 3 Company Entry Description AN i.e. REMITTANCE, PAYMENT 10 Company Descriptive Date DATE Optional Use Descriptive Date for Receiver s bank statement i.e., JAN-03; , 29 Oct 6 Effective Entry Date DATE YYMMDD 6 BPR16

4 Settlement Date N Leave Blank: this is assigned when the file is run 3 Originator Status Code AN Use "1" 1 Originating DFI N Routing and Transit Number without the 8 BPR07 Identification check digit. When BPR06 =01 Batch Number N Batch (Correlates with Batch Trailer) Use " " for first batch then increment by one for each additional batch in this file. 7 ENTRY DETAIL RECORD - Repeat >1 This record is for identifying who is being paid Record Type N Use "6" 1 Transaction Code N Automated Deposit (Credit) = 22 for Checking 32 for Savings Credit Pre-notification = 23 for Checking 33 for Savings Automated Payment (Debit) = 27 for Checking 37 for Savings Debit Pre-notification = 28 for Checking 38 for Savings Receiving DFI N Routing and Transit Number of receiving institution (1st 8 characters) Routing Check Digit N Transit Routing Check Digit of receiving institution 2 BPR08 8 BPR13 1 From BRP 13 DFI Account Number AN Account Number at receiving institution 17 BPR15 Dollar Amount N Right justified and zero filled (ex $$$$$$$cc) 10 BPR02 Identification Number AN Optional B N103 Receiving Individual /Company Name AN Individual or Company Name 22 Discretionary Data AN Optional (Not Used) 2 Addenda Record Indicator N 1 = addenda record follows 1 Trace Number N The first 8 positions contain the ODFI ID (Company batch header) followed by an Entry Counter (use for first record 15 Calculated

5 then increment by one for each Entry Detail Record) ENTRY DETAIL ADDENDA RECORD Record Type N Use "7" 1 Addenda Type Code N Use "05" for CCD Addenda Records 2 Addenda Information AN Use:* as Delimiter and "\" as Segment Terminator This is the TRN segment from the 835 that allows the provider to reconcile this payment to the 835 received. This record includes the ENTIRE TRN segment (including the TRN) and MUST use the * as the delimiter between data elements and the \ as the segment terminator, regardless of what two elements are used in the actual 835 transmission. This field is left justified and space filled. Addenda Sequence Number N Sequence Number of this Addenda Record in relations to the associated Entry Detail Record. For CCD+ use Entry Detail Sequence N This is the same number as the Entry 7 Number Counter from the Trace Number of the Entry Detail Record. COMPANY BATCH CONTROL RECORD One "8" Record for every "5" Record Record Type N Use "8" 1 Service Class code N 220 = Credits 3 BPR03 Entry/ Addenda Count N Total Number of Entry Detail and or Addenda Records Entry Hash N Add up the first eight positions of the Routing and Transit numbers in each Entry Detail record in this batch. If the hash total exceeds 10 digits, the leftmost digits are not included in this field. 6 10

6 Total Debit Amount N Right Justified and zero filled [ex. $$$$$$$$$cc] Total Credit Amount N Right Justified and zero filled [ex. $$$$$$$$$cc] Company Identification AN Usually the Tax ID, preceded by a "1" of the Originating Company) 10 BPR10 Message Authentication Code N Leave Blank 19 Reserved N Leave Blank 6 Originating DFI Identification N Originating DFI ID 8 BPR07 Batch Number N Batch Number " " for first batch then incremented by one for each additional batch 7 FILE CONTROL RECORD - Repeat 1 (One trailer for entire file) Record Type N Use "9" 1 Batch Count N Total number of batches included in the file 6 Block Count N Each Block contains 10 records If the block number count is not a whole number, fill enough records following the File Control Record with "9"s in all spaces to make the block count a whole number. Entry/Addenda Count N Total number of Entry Detail and Addenda records included in the file. Entry Hash N Add up the first eight positions for all Routing and Transit numbers used in all Entry Detail Records in all the batches in this file. If the hash total exceeds 10 digits, the leftmost digits are not included in this field. Total Debit Amount N Zero Filled, Right Justified [ex. $$$$$$$$$$cc] Total Credit Amount N Zero Filled, Right Justified [ex. $$$$$$$$$$cc]

7 Reserved N Leave Blank 39 History Original V2.1 V2.2 ORIGINATION DATE 02/14/2006 7/11/2018 APPROVAL DATE 02/07/2007 8/1/2018 EFFECTIVE DATE 03/07/2007 9/1/2018