User:Julierb05

FSPO Wiki

ICL- An Image Cash Letter is a replacement check that is printed on paper in the event that a bank is not able to process and clear a check using an electronic image of the check.

Check 21- The Federal Banking System has implemented a new check processing rule called Check 21. It allows checks to be cleared through the financial system using a certified “true-copy” image of the check rather than processing the physical paper check. This process will simulate the EFT process in the current ePayment program.

Check Conversion- The process of replacing a paper check with an electronic check image.

ERA- An Electronic Remittance Advice is an electronic version of a payment explanation which provides details about providers' claims payment, and if the claims are denied, it would then contain the required explanations. ERA’s are provided by plans to Providers. The industry standard for sending ERA data is the HIPAA X12N 835 standard.

835- A standard format used when sending ERA’s.

Drawdown- The initiation of an ACH debit from the Payers bank account by Emdeon.

ACH- The ACH Network is a highly reliable and efficient nationwide electronic funds transfer (EFT) system. ACH is widely adopted by financial institutions throughout the country, and provides a great deal of efficiency and standardization in the processing of electronic payments.

NACHA- They are an electronic payment system organization known today as The Electronic Payments Association, but formerly as the National Automated Clearing House Association. NACHA manages the development, administration, and governance of the ACH Network. NACHA is a not-for-profit association that represents more than 11,000 financial institutions through direct memberships and a network of regional payments associations, and 585 organizations through its industry councils. NACHA develops operating rules and business practices for the Automated Clearing House (ACH) Network and for electronic payments in the areas of Internet commerce, electronic bill and invoice presentment and payment (EBPP, EIPP), e-checks, financial electronic data interchange (EDI), international payments, and electronic benefits services (EBS).

Electronic Billing (General) is the electronic delivery and presentation of financial statements, bills, invoices, and related information sent by a company to its customers. Electronic billing is referred to by a variety of terms,including the following:

EBPP- Electronic Bill Presentment & Payment (typically focused on business-to-consumer billing and payment)

EBIP- Electronic Invoice Presentment and Payment (typically focused on business-to-business billing and payment)

EFT- Electronic funds transfer is a payment method utilizing electronic means (as contrasted with paper checks) to transfer funds between parties. The two most common forms of EFT in healthcare payments are ACH’s and Fedwires. An ACH transaction usually takes between 1 – 2 days to clear electronically, while a Fedwire has same-day fund accessibility. Fee structures vary considerably between the two forms of EFT.

CASS Bank- Emdeon's banking partner

EOB- Explanation of Benefits for the insured

EOP- Explanation of Payments for the provider

NPI- National Provider Identifier, a 10 digit unique number assigned to a provider or a provider group/facility. This is required for processing claims.

AFF- Alternate File Format

EBS- Emdeon Business Services

EDI- Electronic Data Interchange, refers to the structured transmission of data between organizations by electronic means. It is used to transfer electronic documents from one computer system to another (ie) from one trading partner to another trading partner.

TPA- Third Party Administrator, is an organization that processes insurance claims or certain aspects of employee benefit plans for a separate entity

Gap Analysis- Compare inbound print data files to what is needed to created a 100% compliant outbound file.

Print Conversion- provider driven product, we create 835(non compliant/95% compliant) file from inbound print data file

EDIFECS- a testing tool that provides errors on a submitted 835 file

SNIP Level Errors- part of EDIFECS, Levels 1 through 3 will cause the 835 to fail validation. Levels 4 and 5 will generate warning level errors; however, the 835 will be valid.

Positive Pay File- Bank reconciliation of manual checks for balancing purposes

Production Register- shows ACH vs manual checks in file