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Electronic Transaction Toolkits for Administrative Simplification

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The AMA is committed to reducing administrative burdens on practices. Physicians and practice staff spend hours dealing with complex issues surrounding the insurance claim payment process, including prior authorizations, patient eligibility inquiries, claim filing and payment reconciliation, costing the practice money and time that could be better spent on patient care.

Physicians and their staff can reduce the time spent on these burdensome processes by implementing standard electronic health care transactions to complete practice revenue functions. The AMA’s Electronic Transaction Toolkits offer a wealth of information to help practices transition to electronic processes and improve the efficiency of their business.

General Electronic Transaction Resources

The following AMA-developed resources provide an overview of the standard electronic transactions mandated by the Health Insurance Portability and Accountability Act (HIPAA), offer implementation guidance and detail actions practices can take if they encounter health plan compliance issues.

Webinar: "HIPAA Standard Transaction Compliance: Physician Rights and Enforcement"

    Specific Electronic Transaction Resources

    Electronic Payments

    In recent years, health plans have shifted from paper checks to electronic methods of physician payment. Health plans are required to offer electronic funds transfer (EFT) payments using the Automated Clearing House (ACH) Network to practices that request this method of claims payment. Additionally, many health plans have started paying physicians through virtual credit cards (VCCs), which are processed using standard credit card technology but can result in significant lost revenue for practices. The following resources provide information and guidance to physicians on electronic payments.

    Electronic Remittance Advice (ERA) Toolkit

    Learn how to efficiently reconcile payments and make the most of this standard electronic transaction:

    Electronic Prior Authorization (ePA) Resources

    The AMA believes that prior authorization is currently overused and that existing authorization processes are extraordinarily burdensome to physicians and their practice staff. To learn about the AMA’s efforts to reduce the time and money wasted on prior authorization, including guidance on how practices can transition to an automated ePA process, see Addressing Prior Authorization Issues.

    Electronic Eligibility Verification Toolkit

    Use the following resources to leverage the electronic eligibility transaction to determine patient insurance coverage and benefits in a timely and less burdensome manner.

    Electronic Claims Toolkit

    The AMA, in collaboration with the Medical Group Management Association, developed the Electronic Claims Toolkit (PDF) to help physicians and practice staff understand the electronic claim submission process and maximize the benefits and efficiencies of an automated process.

    Workers’ Compensation and Auto Injury Toolkit

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