Insurers not paying correctly? Free tool helps address denials


A newly updated online tool can help your practice ensure accurate payment of claims and appeal inappropriate denials. The Claims Workflow Assistant, developed by the AMA, can help your practice understand digital explanations of payment known as electronic remittance advice (ERA) transactions and address any issues with how the insurer handled your claims.

While the electronic claims process can improve health care billing efficiency and reduce administrative burdens and costs, physicians can’t gain these full benefits without understanding and being able to act upon the coding used in these transactions.

The Claims Workflow Assistant makes it easier for your practice to:

  • Look up codes used in ERA transactions
  • Fully understand the code meanings
  • Review recommended step-by-step work flows for addressing claim denials and non-payments

This tool recently was updated to reflect the latest code combinations that could be used in insurers’ responses to your claims. AMA members also have access to appeal letter templates for contesting claim payments.

If your practice hasn’t yet adopted ERA transactions, the AMA offers an ERA toolkit with detailed information about transitioning to using these transactions. Additional tools to streamline practice work flows are available on the AMA’s “administrative simplification initiatives” Web page.