Administrative Burden Index - Score 3
Administrative burden associated with identifying prior authorization requirements and performing prior authorization
Data for these are taken from the NHIRC "Metric 7": Prior authorization frequency.
The AMA's goal is to move the health care system to achieve 100 percent automation and transparency of the prior authorization process, which will significantly lower administrative burdens for both the physician practice and the payer.
 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.
- 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.