Administrative Burden Index - Score 5
Administrative burden associated with undisclosed claim edits
Data for these scores are taken from the NHIRC "Metric 10": Percentage of total claim lines reduced to $0 by undisclosed claim edits.
"Metric 10" outlines on what percentage of claim lines does the payer apply a claim edit, which the payer has not disclosed on its website or in other provider communications, that reduces the payment (allowed amount) of the claim line to $0.
An online claim editing tool that requires manual entering of each and every code pair to determine whether an edit will apply does not meet this definition.
“Readily accessible information,” as used in the NHIRC, on edits means that a qualified health care professional that accesses payer policy statements and payment rule information from the payer’s website is able to exactly create the full scope of a specific edit rule without additional information from the payer.
The AMA's goal is that applied claim edits be 100 percent publically sourced. The lack of transparency of payer-specific edits adds substantial administrative costs for physicians trying to reconcile claims.
 All scores in the Administrative Burden Index refer to metrics outlined in the National Health Insurer Report Card. Visit www.ama-assn.org/go/reportcard for full metric descriptions and methodology.
 To be considered a “disclosed edit” for the purposes of the NHIRC, the complete scope of an edit rule must be disclosed. Access “2013 National Health Insurer Report Card: Statement of methodology, including the step-by-step guidance” for more detailed information.
- Automate claims revenue cycle workflows through the use of electronic transactions, with help from the AMA's toolkits at www.ama-assn.org/go/electronictransactions, or through use of the AMA's Claims Workflow Assistant at www.ama-assn.org/go/claims-assistant.
- Take advantage of automated solutions offered by payers, which are highlighted at
www.ama-assn.org/go/payerpolicies on the AMA's payer policies website.
- Move toward point-of-care pricing with help from the AMA's toolkit available at www.ama-assn.org/go/poc.
The ABI score was created to assist physicians in identifying the cost of doing business with the participating payers in the NHIRC. For simplicity, a grading scale, similar to educational system grading scales which use 0-100 point scales, was utilized. An exception was made so that a score of 100 points was required to receive five stars, instead of the traditional 90-100 points for the top grade.
Therefore, an ABI score of:
- 100 is equal to five stars
- 90-99 is equal to four stars (95-99 is awarded an additional ½ star)*
- 80-89 is equal to three stars
- 70-79 is equal to two stars
- 60-69 is equal to one star
- 59 or lower is equal to zero stars
*Payer scores of 95-99 that fell in the 4 star category were given additional recognition of a ½ star to acknowledge their efforts to reach the AMA goals.