What does the term "clean claim" refer to?

The term "clean claim" refers to claims that are error-free and meet all payer requirements. In healthcare revenue cycle management, a clean claim is essential for ensuring timely payment and efficient processing. This means that all necessary information is accurately included, such as patient demographics, service codes, and supporting documentation, aligning with the criteria set by the payer. When claims are clean, they increase the chances of quick approval and payment, minimizing the administrative burden on healthcare providers.

In contrast, claims that are processed manually may not necessarily meet the standards of a clean claim, as manual processes can introduce errors. Claims submitted after patient discharge can be valid but do not inherently qualify as clean claims unless they also fulfill the complete requirements. Claims that require additional documentation indicate that there are issues or errors present that need to be addressed, which would disqualify them from being clean.