Claims Workflow Assistant Home
The American Medical Association's Claims Workflow Assistant is for guidance only. The AMA does not guarantee the outcomes resulting from use of the Claims Workflow Assistant with respect to specific claims. The AMA does not provide legal advice. Consultation with legal counsel may be appropriate to help identify and pursue claims that should be appealed. Visit the AMA Administrative Simplification Initiatives website at www.ama-assn.org/go/simplify for additional information and resources
Welcome to the AMA’s Claims Workflow Assistant. Use this tool to identify claims adjustment group, reason and remark codes that describe reasons for claim denials received on electronic remittance advices (ERA)1. Look up features include claims workflows, Claims adjustment group codes (CAGC)1, Claims adjustment reason codes (CARC)2 and Remittance advice remark codes (RARC)3.
View the instructions and glossary for using the Claims Workflow Assistant tool. For additional information on Electronic Remittance Advice (ERA), visit the AMA’s ERA Toolkit. The AMA also offers resources to assist with other electronic transactions, available on the electronic transaction toolkits website.
1Copyright © 2000-2002 Data Interchange Standards Association on behalf of ASC X12.
2Claim Adjustment Reason Code (CARC) Source: Blue Cross and Blue Shield Association
Visit Washington Publishing Company at www.wpc-edi.com/codes to obtain a complete listing of the Claim Adjustment Reason Codes (CARC) and to propose new or request a revision to existing CARCs.
3Remittance Advice Remark Code (RARC) Source: Centers for Medicare & Medicaid Services OIS/BSOG/DDIS. Visit Washington Publishing Company at www.wpc-edi.com/codes to obtain a complete listing of the Remittance Advice Remark Codes (RARC) and to propose new or request a revision to existing RARCs.
AMA members have the advantage: activate your AMA membership today to optimize the Claims Workflow Assistant. AMA membership is also your gateway to members-only resources, such as, free unlimited online access to JAMA, AMNews, Archives journals and links to several tools, such as, the interactive appeal letter templates that help you quickly generate appeals for denied claims. The AMA has resources for you at every stage of your career.
Activate your membership today, visit www.ama-assn.org/go/join or call AMA Member Relations, 24 hours a day, 7 days a week at (800) 262-3211.