What is Clean Claim?

A claim is one that will pass through all front-end edits to the insurance processing units through an electronic clearing house. If there is an error in the claim then the claim will not reach the insurance in that case the claim will be rejected. The biller will check for the error that occurred and needs to rectify the error and resubmit again until it reaches the insurance. Some of the common errors that need to check are Incorrect patient details such as name, DOB, Sex, insurance ID number, etc. Incorrect provider details such as name, address, credentialing details NPI, TAX id, Taxonomy, etc. Incorrect insurance details such as Incorrect policy number, address or payor id, etc. Incorrect entry of Dx codes with CPT codes, or vice versa, etc.