Ask Caryl: Definition of Clean Claim

Q: What exactly is a "clean claim"?

Caryl: A clean claim is one that is submitted on the appropriate claim form (paper or digital) with the required information specified by the insurance contract. In addition, if your ASC's contract specifies other information be attached (e.g., operative note, invoice), this information must accompany the claim to constitute a clean claim submission.

Submission of a clean claim benefits your ASC by providing accurate, timely reimbursement of services provided. Be sure to review your contracts to ensure your initial claims are being submitted appropriately. By understanding and meeting contract requirements, you can safeguard against additional information requests by payers. Additionally, it’s important to understand your state's clean claim and prompt payment statutes.

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