The American Medical Association has created a Health Insurer Code of Conduct Principles and challenges payers to commit to following the code.

Several of the 10 principles relate to the use of information technology. Provisions under the third principle, Access to Medical Care, call for provider directories to be easily available in paper and electronic formats. Both formats should provide specific information, including clear disclosures if a provider is in a restricted "tier" of coverage or "out of network," along with terms of financial and access limitations.

Under the Administrative Simplification principle, the AMA calls for insurers to comply with all laws governing use of electronic transactions, and the dissemination of clear, timely and accurate eligibility and benefit information on request, among other provisions.

The Claims Processing Principle demands timely and accurate payment with clear and comprehensive explanations of how each claim was handled and specific reasons for denial or reduction of payment.

The complete code, which 68 state and specialty medical societies have endorsed, is available at ama-assn.org/go/codeofconduct.

--Joseph Goedert

 

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