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 paters 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. Feel free to share the AMA testimony referenced above with them, so they will have a clear understanding of the 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.
- Evaluate your vendor's functionality: Take the brief HIPAA Transaction Code Set Vendor Survey to easily find out whether your vendors can process electronic claims and other health care transactions. Encourage your vendor to utilize acknowledgement transactions.
- Visit 5010 electronic administrative transactions for more information on assessing 5010 readiness.
- Beyond the Claim: HIPAA 5010 Administrative Simplification Opportunities to Positively Impact your Revenue Cycle
- The Real World of Electronic Claims Acknowledgements