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:

• This Checklist Gets You Clean Claims
• Elements of a Compliance Plan
• Medical Practice Management Consultant for Physicians 

About the Author

Reed Tinsley CPA

This article is written by Reed Tinsley, a Houston, TX-based CPA with over 30 years of experience advising physicians and medical practices across Texas and the United States. Reed holds certifications as a Certified Valuation Analyst (CVA), Certified Healthcare Business Consultant (CHBC), and Certified Financial Planner (CFP), specializing exclusively in the healthcare sector. He is a published author, nationally recognized speaker, and trusted advisor to physicians on accounting & tax, practice management, and financial planning. Schedule a Free Consultation.