Claims processing resources

Claims submission, processing, adjudication and payment have become increasingly complex and present a significant administrative and technological challenge for physician offices. However, it is critical that physicians and their office staff understand these processes to ensure proper payment for services and to detect improper reimbursement practices.

The AMA's Private Sector Advocacy (PSA) unit has developed the following tools to help physicians navigate the maze of the claims submission process.

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Follow that Claim: Claims Submission, Processing, Adjudication and Payment

Prepare that Claim (PDF, 1,015KB)

Appeal that Claim (PDF, 2MB)

Claims Management Letters/Templates

The effect a payer's claim edits can have on the repricing and payment of your claim (PDF, 262KB)

Helping your patients understand their billing and payment responsibilities (PDF, 324KB)

*Appointment Scheduling to Improve your Bottom Line (PDF, 513KB)

How to Appeal Inappropriate Health Plan Claim Denials (PDF, 107KB)

How to Perform a Physician Practice Internal Billing Audit (PDF, 599KB)

How to Prepare for a Health Plan Retrospective Audit (PDF, 229KB)

*The AMA and the Kentucky Medical Association would like to thank the members of the Kentucky Medical Group Management Association for their contributions made in the development of these educational fliers.