What defines a "clean claim" in the context of healthcare billing?

A "clean claim" in healthcare billing is defined as a claim that contains all necessary information for payment determination. This means that the claim must accurately include details such as patient information, service codes, provider information, and any other required data that payers, including insurance companies, need to process and adjudicate the claim without further inquiry or correction.

Clean claims are essential for ensuring prompt payment and reducing administrative delays. When claims are clean, they are more likely to be processed quickly, as they do not require additional follow-up or corrections that might arise from missing or erroneous information. This helps healthcare providers maintain a steady cash flow and minimize costs associated with claim resubmission or appeals.

In contrast, claims submitted with delays, those that have been denied, or claims that require further verification before submission do not meet the criteria of a clean claim, as they may introduce complications or require additional processes before payment can be finalized.