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.
Learn more about what the AMA is doing to raise the priority of acknowledgement transactions in the AMA's testimony "The Acknowledgement Transaction Standard" that was presented to the National Committee of Vital Statistics. The AMA is requesting that these health care standards are made mandatory under HIPAA.
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. Feel free to share the AMA testimony referenced above with them, so they will have a clear understanding of the Accredited Standards Committee (ASC) X12 standards that are already available to support this valuable business process.
Calculate your potential savings: View Aetna's EDI savings calculator to determine your potential practice savings.
- Access the AMA resource "Understanding the HIPAA standard transactions: The HIPAA Transaction and Code Set rule" for an overview of electronic health care transactions.
"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.
Visit www.ama-assn.org/go/payerpolicies to access online resources from health insurers to help you move towards practice automation.
The suite of electronic health care transactions are designed to work together to create greater efficiencies for both physicians and health insurers. By adopting an integrated approach to using the electronic health care transactions, information gained from one transaction becomes useful information in the next transaction.
- Did you know that the increased use of electronic health care transactions in your practice, such as the electronic eligibility benefit inquiry and response transactions, has the potential to save physicians and health insurers nearly $30 billion per year? 
Access this case study to learn more about the savings your practice can experience using electronic health care transactions.
 U.S. Healthcare Efficiency Index, www.ushealthcareindex.com