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Three Key Affordable Care Act-Related Changes

Standardizing, streamlining and simplifying business

New ways of doing business mean simplified processes for providers. As a result of the Affordable Care Act (ACA), you will begin to see some business changes in how you access, submit and receive information from Wellmark.

 

Access to electronic registration forms

Available in the fourth quarter of 2013, an updated electronic funds transfers (EFT) enrollment form and a new electronic remittance advice (ERA) enrollment form will be accessible to providers on the secure provider page at Wellmark.com. These updated and new forms mean providers can quickly and easily access and submit requests to Wellmark electronically.

When available, the updated EFT and ERA online forms will help you easily request:

  • initial enrollment for EFT or ERA.
  • changes to existing EFT or ERA enrollment.
  • cancellation of your EFT or ERA enrollment.

EFT and ERA reassociation

In addition to the new EFT and ERA forms, the ACA requires carriers to apply a trace or tracking number to the ERA and the associated EFT. Since the EFT and the ERA are sent to the provider separately, the trace or reassociation number will allow you to efficiently match the payment to the ERA and eliminate the need for costly manual reconciliation.

 

Standardized reporting on ERA

The ERA explains the payment a provider receives for a service claim. If a service is denied or the payment adjusted, the ERA contains the required explanations in the form of Claim Adjustment Group Codes (CAGC), Claim Adjustment Reason Codes (CARC), and Remittance Advice Remark Codes (RARC). The Committee on Operating Rules for Information Exchange (CORE) has established a minimum set of CORE defined claim adjustment/denial business scenarios and a maximum set of CORE required CARC/ RARC/CAGC combinations for each scenario. The necessary system changes to align with these CORE defined scenarios will be completed by Wellmark in November 2013.

 


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