Juliana Bryant
What is a clean claim?
A clean claim is a successfully processed and reimbursed insurance claim. A clean claim has no errors, rejections, or need for manual intervention or additional data.
Having a high rate of clean claims demonstrates an organization’s ability to capture and enter quality data the first time. Submitting a clean claim leads to quicker reimbursement and account resolution.
Criteria for a Clean Claim:
- A clean claim is submitted by a licensed healthcare provider.
- The coverage of a clean claim was in effect on the date that the organization provided the healthcare service. Also, the services covered must be under the patient’s health insurance.
- To eliminate questions on medical necessity, procedure codes must support the diagnosis codes.
- All the codes used on the claim must be current.
- All information must be correct and placed on the appropriate fields of the claim form.
- Accurate identification of payer, including the payer ID and the mailing address.
- The claim must submit it within a specified time.
- Any other required supporting documents are provided.
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Juliana Bryant
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