Clean Claim definition

Clean Claim means a claim that:

Clean Claim means a claim (i) that has no material defect or impropriety (including any lack of any

Clean Claim means a claim received by an insurer for

Examples of Clean Claim in a sentence

• In cases where a Clean Claim is not submitted by the PROVIDER within one (1) year of the CONSUMER’s discharge, the PAYOR shall not be required to authorize payment, unless otherwise mutually agreed upon in advance between the PROVIDER and the PAYOR.

• Clean Claim – A claim that can be processed without obtaining additional information from the Provider of the service or from a third party.

• Clean Claim: A claim submitted by a Provider for medical care or health care services rendered to a Covered Person, with the data necessary for United to adjudicate and accurately report the claim.

• In cases where a Clean Claim is not submitted by the PROVIDER within one (1) year of the CONSUMER’s date of service, the PAYOR shall not be required to authorize payment, unless otherwise mutually agreed upon in advance between the PROVIDER and the PAYOR.

• Clean Claim – A claim that can be processed without obtaining additional information from the provider of a service or from a third party.

More Definitions of Clean Claim

Clean Claim means clean claim as defined in 2001 Iowa Acts, chapter 69, section 8(2b).

Clean Claim means a claim that has no defect or impropriety, including any lack of required substantiating documentation, such as satisfactory evidence of expenses incurred, or particular circumstance requiring special treatment that prevents timely payment from being made on the claim.

Clean Claim means a claim submitted for payment that has no defect, impropriety, or particular circumstance requiring special treatment preventing payment.

Clean Claim generally means a claim that has no defect, impropriety or special circumstance, including incomplete documentation that delays timely payment.

Clean Claim means a Claim that has no defect or impropriety, including a lack of required substantiating documentation, or particular circumstances requiring special treatment that prevents timely payment from being made on the Claim. A Claim is clean even though Plan refers it to a medical specialist within Plan for examination. If additional documentation (e.g., a medical record) involves a source outside Plan, then the Claim is not considered clean.

Clean Claim means a claim that (i) identifies the PRACTITIONER that provided the service sufficiently to verify the affiliation status and includes any identifying numbers; (ii) sufficiently identifies that patient is a BCBS member; (iii) lists the date and place of service; (iv) is a claim for Covered Services for an eligible individual; (v) if necessary, substantiates the medical necessity and appropriateness of the service provided; (vi) if prior authorization is required for certain patient services, contains information sufficient to establish that prior authorization was obtained; (vii) identifies the service rendered using an accepted system of procedure or service coding adopted and published by BCBSM; (viii) includes additional documentation based upon services rendered as reasonably required by BCBSM.

Clean Claim means a claim that has no defect or