Clean Claim Sample Clauses
A Clean Claim clause defines the requirements for a healthcare claim to be considered complete and ready for processing by an insurer or payer. Typically, this clause outlines the necessary information and documentation that must accompany a claim, such as patient details, service codes, and provider identification, ensuring there are no errors or omissions. By establishing clear standards for claim submission, the clause helps prevent delays in payment and reduces administrative disputes, ultimately facilitating timely reimbursement for healthcare providers.
POPULAR SAMPLE Copied 2 times
Clean Claim. Definition
Clean Claim. A Claim that can be processed without obtaining additional information from the provider of the service or from a third party, with or without Claim Attachment(s). It may include a Claim with errors originating from the Contractor’s claims system. It may not include a Claim from a Provider who is under investigation for fraud or abuse, or a Claim under review for Medical Necessity.
Clean Claim. A claim for payment for a health care service, which has been received by ACDE, has no defect or impropriety. A defect or impropriety shall include a lack of required substantiating documentation or a particular circumstance requiring special treatment that prevents timely payment from being made on the claim. Consistent with 42 CFR §447.45(b), the term shall not include a claim from a health care provider who is under investigation for fraud or abuse regarding that claim, or a claim under review for medical necessity.
Clean Claim. A claim that: (1) has no defect, impropriety, lack of any BCBSM required substantiating documentation or particular circumstance requiring special treatment that prevents timely payment; and (2) otherwise conforms to the clean claim requirements for equivalent claims under original Medicare.
Clean Claim. As defined by Miss. Code ▇▇▇. § 83-9-5, a Clean Claim refers to a claim received by an insurer for adjudication and which requires no further information, adjustment or alteration by the provider of the services or the insured in order to be processed and paid by the Contractor.
Clean Claim. Definition
2 4.1 TERM
Clean Claim. A Claim that can be processed without obtaining additional information of the service from the provider or the provider’s designated representative as further defined in the HMSA QUEST Participating Provider Handbook.
Clean Claim. A Clean Claim means a claim for payment for Contracted Services that contains all the required data elements necessary for adjudication, without requesting supplemental information from the submitter, as required by the VA CCN Requirements.
Clean Claim. A Claim submitted by a physician or Provider for health care services rendered to an Enrollee, with the data necessary for the STAR+PLUS MMP or subcontracted Claims processor to adjudicate and accurately report the Claim. A Clean Claim other than a Nursing Facility Unit Rate Clean Claim must meet all requirements for accurate and complete data as defined in the appropriate Claim type Encounter guides as follows:
1.25.1. 837 Professional Combined Implementation Guide;
1.25.2. 837 Institutional Combined Implementation Guide;
1.25.3. 837 Professional Companion Guide;
1.25.4. 837 Institutional Companion Guide; or
1.25.5. National Council for Prescription Drug Programs (NCPDP) Companion Guide
Clean Claim. Unless otherwise required by law or regulation, a claim which: (a) is submitted within the proper timeframe as set forth in this Agreement; (b) has: (i) detailed and descriptive medical and patient data;