Endocrine Insider
October 28, 2009

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A new online tool has been created by the American Medical Association to help physicians determine the reasons behind claim denials and the best course of action to reverse them. Named the Claims Workflow Assistant, this free tool can be used to identify the claims adjustment group and the reason and remark codes that describe the denials received on electronic remittance advices (ERA). The tool was developed for guidance only and does not ensure the reversal of a denied claim.

 The Claims Workflow Assistant includes look-up features on claims workflows, claims adjustment group codes (CAGC), claims adjustment reason codes (CARC), and remittance advice remark codes (RARC). Physicians are also able to enter the unique combination of CAGC, CARC, and RARC codes in order to generate template letters that can be used to appeal claim denials.

Additional information on this new resource, including the features described above, can be found on the American Medical Association’s website at http://97.65.39.51/AMADenialManagement/default.aspx#.