Submit a clean claim
(refer to Provider Manual Chapter 5)
This commonsense legislation would bring greater transparency to pharmacy payments by informing pharmacies at the point of sale what their reimbursement will be for clean claim
prescriptions and allow for better business planning," the letters concluded.
He added that the VA offers providers training on how to submit a clean claim
Neisha's stance on rapid clean claim
submission has enabled Medivance Billing Service to transmit on average, over $65 million in claims monthly for their clients.
A clean claim
is a claim that has no defect or impropriety or particular circumstance requiring special treatment that prevents timely payment from being made.
Definitions of terms such as clean claim
, insurer, provider, etc.
a) A licensed insurer or a managed care plan shall pay a clean claim
submitted by a health care provider within forty-five (45) days of receipt of the clean claim
A clean claim
, according to Congress, is one "that has no defect or impropriety .
When the encounter information is submitted the system performs insurance eligibility, codes the performed services according to the receiving payer's rules, checks charges against the appropriate fee schedule and electronically submits a clean claim
to the payer.
residents who are disabled or are over age 65, defines a clean claim
as a "claim that has no defect of impropriety, including lack of required substantiating documentation .
But if meeting a state's clean claim
requirement would result in a violation of HIPAA, then that state law is going to be preempted.
However, private insurers have policies in place related to timeliness of filing--some companies require a clean claim
to be filed in 30 days or less, whereas Medicare and Medicaid are normally 365 days for a clean claim
to be filed.