Clean Claim Submission
Clean Claim Submission
Clean Claims Submission is the foundation of a successful Revenue Cycle Management (RCM) process. A clean claim is one that is error-free, contains accurate patient and provider information, complies with payer/state/federal guidelines and is submitted correctly the first time-resulting in prompt and full reimbursement without delays, denials or reworks.
Key Elements to a Clean Claim Submission:
* Accurate Patient Information and Eligibility Verification : Verify patient demographics, insurance details, and eligibility before submission
* Correct Coding- Use up-to-date ICD-10, CPT and HCPCS codes that accurately reflect the services provided. Ensure that all CMS and NCCI rules and regulations are followed.
* Proper documentation: Ensure medical records support the billed services, including provider notes and authorizations when required.
* Timely submission- File claims within the payer-s deadline to avoid denials due to timely filing limits.
* Prevention of Duplicate Claims: Track submissions and avoid refiling unless necessary to correct an issue.
* Claims Scrubbing & Auditing- Utilize billing software or clearinghouse to detect and correct errors before submission
* Follow-up & Appeals- Monitor claims status, address rejections quickly, and appeals denials with supporting documentation when needed.
By ensuring a clean claim submission, healthcare providers can reduce delays, minimize denials, and improve revenue cycle efficiency.