Medical Billing: Filing a Clean, Error-Free Claim
Part of the Medical Billing & Coding For Dummies Cheat Sheet
A clean medical claim is one that has no mistakes and can be processed without additional information from the provider or a third party. It's correct from top to bottom. A clean medical claim meets the following criteria:
The healthcare provider is licensed to practice on the date of service and is not under investigation for fraud.
Every procedure code has a supporting diagnosis code, which eliminates any questions about medical necessity. In addition, the form includes no expired or deleted codes.
The patient's coverage was in effect on the date of service, and the patient's insurance covers the service provided.
The claim form includes all the required information (patient name, address, date of birth, identification number, and group number) in the correct fields.
The form correctly identifies the payer and includes the right payer identification number and payer mailing address.
The claim is submitted on time.