Claims Acknowledgement Toolkit
Acknowledgements are confirmations--just like making a phone call and receiving the "hello" from the person who picked up the phone confirming that someone is there. Acknowledgements confirm that a transaction is received. However, the acknowledgement electronic health care transactions are not mandated under the Health Insurance Protection and Accountability Act (HIPAA), and therefore are not required to be used by payers or other intermediaries in the claims revenue cycle. AMA is advocating to change this and require that all payers acknowledge receipt of electronic health care transactions so physicians will no longer have any doubt as to whether, and when, an electronic transaction was received.
Even though payers are not required by law to support the electronic acknowledgement transactions, some of them have voluntarily done so. Ask the clearinghouses and payers you work with whether they will provide electronic acknowledgements and urge those that haven't yet adopted these transactions to do so as soon as it is feasible. Also ask your practice management system vendor if it accepts and processes acknowledgements.
Calculate your potential savings: View Aetna's EDI savings calculator to determine your potential practice savings.
"Considerations for processing electronic transactions in the physician practice" offers specific scenarios of how your practice might adopt electronic transactions, and provides additional considerations for your specific situation.
- “Questions to ask a health insurer before enrolling in an electronic transactions program” outlines key issues with using electronic transactions that you need to carefully consider.
- “Questions to ask a billing service before enrolling in an electronic transactions program” provides key questions to discuss with your billing service to understand how it can assist you in using electronic transactions.
- “Questions to ask a clearinghouse before enrolling in an electronic transactions program” provides key questions to discuss whether your clearinghouse provides satisfactory functionality for electronic transactions.