5 Quick Tips For a Clean Claim

Tips for Filing a Clean Claim

Errors in physician billing are common. One of the most common errors is the failure to electronically file a clean claim. Sample Texas law definition is here.

A clean claim has no defect, impropriety or special circumstance, including incomplete documentation that delays timely payment. A provider submits a clean claim by providing the required data elements on the standard claims forms, along with any attachments and additional elements, or revisions to data elements, attachments and additional elements, of which the provider has knowledge. Claims for inpatient and facility programs and services are to be submitted on the UB-04 and claims for individual professional procedures and services are to be submitted on the CMS-1500. State guidelines may supersede these requirements. In addition, claims may be submitted electronically through a contracted clearinghouse. Some payers do not typically, but may require attachments or other information in addition to these standard forms. As many of you know, many of the payers may request treatment records for review after you file your claim.

Working with clients and billing companies, the following are five quick tips to file a clean claim out of your physician office:

  • No Spaces in the patient Insurance ID
    Even though the ID card may have spaces, the electronic claim form cannot in order to file a clean claim.
  • No symbols in the patient ID
    No dashes, no slashes, no asterisks.
  • Do not add plan type from card in the group number field
    For example, “Plan F” cannot be listed in the group number field. This is for a numerical group number only.
  • Do not add any symbols or additional letters to the authorization number given by the carrier
    For example, list the exact authorization number given by the carrier. No extra characters or words should be listed here in order to file a clean claim.
  • Do not add notes in the Authorization box
    For example, “No auth Required”. Always leave this field blank if authorization is not required. This will cause the claim to be denied.

Additional Resources on Claims:

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