Why Is It Important To Prepare A Clean Claim? What Suggestions Might You Make To Ensure That Submission Of A Clean Claim Takes Place? Provide Examples.


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Lia Louis Profile
Lia Louis answered
A clean claim is a claim in the healthcare field that is processed without being returned.

Clean refers to the fact that there are no errors. It’s very important for a clean claim to be prepared so that it doesn’t get returned and therefore speeds up the process of payment. When the provider fills out the forms to send in to the insurance company, they need to ensure they fill out the form correctly and in its entirety.

There are many things that can cause a claim to not be a clean claim and therefore be returned. Many of this is missing data. It’s important that the forms get filled out in their entirety, including names, addresses, birthdates, and claimant codes. Many medical providers have a second person check over all claims to ensure there is nothing missed before the claim is sent in.

It’s also important that all the data on the claim is correct. If something doesn’t match, the processing stops and the claim is returned.

Things to double check include the spelling of names, the address, wrong birth dates and even the zip code. It’s very common to switch the names of the claimant and the primary holder of the insurance. This seems like a very simple mistake, but it could create several weeks in delay for the claim to be processed.

A clean claim will allow for quicker payment and will ensure that the correct insurance gets billed, the right patient is charged and so on.

When a claim is made incorrectly, it can cost time and money. It will require going back to the provider for the errors to be corrected. It will then be more difficult to complete because the files of the patients have been filed again, so it will require research to correct any and all mistakes.
Anonymous Profile
Anonymous answered
HCR/220 WEEK 8 DQ 2
A clean claim is a healthcare claim that is free of errors and has been excepted by the payers. Healthcare claims can be rejected by payers for simple errors such as insufficient information regarding data elements that are required in the claim forms. Insufficient data elements can be missing information in an address, wrong zip code, incomplete names, wrong birth date, and even switching the numbers up in a zip code. Something as simple as some of the things listed above can be the cause for rejected claim therefore, it is extremely important to ensure the information is correct before the claim is released.

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