Medical Billing: Filing a Clean, Error-Free Claim - dummies

Medical Billing: Filing a Clean, Error-Free Claim

By Karen Smiley

Part of 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.