Clean Claims. A truthful, complete and accurate claim. A claim that does not have to be returned for additional information.
Clean Claims means claims that may be processed without obtaining additional information from the subcontracted provider of care, from a noncontracting provider or from a third party but does not include claims under investigation for fraud or abuse or claims under review for medical necessity.
Clean Claims means a claim submitted that has no defect, impropriety, or particular circumstance requiring special treatment preventing payment. If We have not received the information We need to process a claim, We will ask for the additional information necessary to complete the claim. You will receive a copy of that request for additional information, for Your information. In those cases, We cannot complete the processing of the claim until the additional information requested has been received. We will make Our request for additional information within 30 days of Our initial receipt of the claim and will complete Our processing of the claim within 15 days after Our receipt of all requested information. Claims submitted by Providers are also governed by Indiana Code § 27-13-36.2.
Examples of Clean Claims in a sentence
BCBSM will process Provider's Clean Claims submitted in accordance with this Agreement in a timely fashion.
Clean Claims and Submission RequirementsComplete a CMS 1500 or UB-04 form whether you submit an electronic or a paper claim.
Claims under investigation for Fraud or Abuse or under review to determine if they are Medically Necessary are not Clean Claims.
Health Plan shall ensure that Clean Claims are adjudicated promptly in accordance with applicable statutory and regulatory requirements.
Alliant will evaluate Clean Claims to ensure that the charges are correct and proper, billed using the most accurate and appropriate Current Procedural Terminology (CPT), International Classification of Diagnosis (ICD), Healthcare Common Procedure Coding System (HCPCS) and Revenue codes, and if applicable, documented in the medical records.
More Definitions of Clean Claims
Clean Claims means a properly completed claim for payment for Designated Covered Services received by THP from Agent or Provider that, in the determination of the Designated Paying Agent, is complete (i.e., requires no further information, documentation, adjustment or alteration by Provider in order to be processed or paid), that is not contested or denied by the Designated Paying Agent (i.e., not reasonably believed to be incorrect or fraudulent) and that is not subject to appeal or grievance procedures.
Clean Claims means a request for payment for Covered Services submitted by a Participating Provider or his/her designee on a HCFA 1500 form (or successor form), or the electronic equivalent of this form when billing claims electronically, that contains all of the elements consistent with claims processing rules described under 28 TAC 21.2801 through 21.2816 “Submission of Clean Claims” of the Texas Department of Insurance as they may, from time to time, be revised.
Clean Claims means a claim for services or supplies that can be processed in accordance with the terms of the applicable Benefit Plan's Plan Document without obtaining additional information from the ACS Provider or any other third party, which requests are to go through ACS. It is a claim which has no defect or impropriety. A defect or impropriety shall include a lack of required sustaining documentation as set forth and in accordance with the applicable Benefit Plan's Plan Document or a particular circumstance requiring special treatment which prevents timely payment from being made. A Clean Claim does not include claims under investigation for fraud or abuse, or claims under review for medical necessity, or under review to ensure they do not exceed the maximum amount payable in accordance with the terms of the applicable Benefit Plan, or any other matter that may prevent the charge(s) from being deemed covered expenses in accordance with the terms of the Benefit Plan's Plan Document.
Clean Claims means claims that can be processed by the Department without obtaining additional information from the Contractor.
Clean Claims. A Claim received by the Contractor for adjudication, which can be processed without obtaining additional information from the Provider of the service or from Third Party, as provided in Section 22.4.5.
Clean Claims refers to any claims that will be submitted to a payor. HHSC licensed and supports an Electronic Health Record for the State Hospitals. This software produces claims that need to be sent to a clearinghouse for reimbursement. The successful vendor will be responsible for extracting the data from the electronic health records, formatting the information required and submitting/transmitting the relevant billing information to the appropriate xxxx xxxxx.
Clean Claims means: claims with no missing, incomplete, or inaccurate information. • “Final Adjudication Status” means: A claim is in a ‘pay’ or ‘open’ status. • “Ready For Client Funding” means: claim adjudication/processing is complete and claim is in a ‘pay’ or ‘open’ status and check register has been generated. Customer Service Average Telephone Response Time Plan Participant calls will be Answered by a representative on average within 45 seconds 3.5% • “Answered” means a human representative’s engagement with a Plan Participant. Abandon Rate for Plan Participant Calls Less than 5% of incoming member calls will be abandoned by Plan Participant after 45 seconds 3.5% • “Abandon Rate” calculation shall begin after the member has gone through the Interactive Voice Response system. Systems/Data Transfers System Availability for member portal and app 99.9% System Availability 2.0% System Availability will be calculated quarterly using the following formula (and will be rounded to the nearest one-tenth of a percentage point): i. “System Availability” = [(Base Time – Unscheduled Downtime) / (Base Time)] x 100 1. “Base Time” equals the product of the number of days in the applicable quarter multiplied by twenty-four (24) hours multiplied by sixty (60) minutes, less downtime resulting from a Force Majeure Event. 2. “Unscheduled Downtime” equals the time (in minutes) during which the portal and app is not operational (excluding “Scheduled Downtime”). 3. “Force Majeure Event” means any delay or failure in performance hereunder caused by reason of any occurrence or contingency beyond its reasonable control, including but not limited to acts of God, earthquake, labor disputes and strikes, riots, pandemic, health emergency, and war. 4. “Scheduled Downtime” equals the aggregate total of all minutes of planned and scheduled maintenance performed during the quarter to perform any necessary hardware, OS, network, database, application software maintenance, repair, upgrades, and updates. Claims Administrator must provide five (5) days prior notice for any maintenance to be included as Scheduled Downtime. Claims Administrator will work with Plan Sponsor to determine and use commercially reasonable efforts to schedule downtime after regular business hours, during times that minimize the disruption to operations. Loading of eligibility and claims data files 99.9% of Industry Standard File layouts with valid/clean data within 2 business days of receipt 2.0% a. Industry Standard File mean...