Clean Claim Requirement. Claims for payment submitted to the TPA must constitute “clean claims” which are those claims that are completely and accurately filled out. The TPA shall reject, and shall have no responsibility to pay, any claim that does not include the elements of a clean claim. The TPA shall notify the Provider of the reason for denial; Provider may correct the claim and submit it again for payment. The claim for payment of services must include the following in order to constitute a clean claim: a. Each member’s invoice must be a separate xxxx, including the member's full name; b. Attach a copy of the letter of authorization for each service billed or include the authorization number on your xxxx; c. Invoice must be in readable format; d. Identify charges by service description or procedure code (as indicated on the authorization); e. Actual delivery date(s) of EACH service; f. Number of units of service provided on each date; and g. Total amount billed per service. Claims that are denied payment may be corrected and submitted again, including all of the above elements. Claims that have been partially paid may be resubmitted for reprocessing, following the TPA requirements for reprocessing claims.
Appears in 4 contracts
Samples: Provider Purchase of Services Contract, Service Provider Contract, Service Provider Contract
