What happens if a clean claim is not received by a health plan?

When a clean claim is not received by a health plan, payment is likely to be delayed. A clean claim refers to a claim that has all the required information and is free of errors, making it straightforward for the health plan to process and reimburse. If this clean claim is not submitted, the health plan cannot initiate the review and processing necessary to approve payment. Consequently, the absence of a clean claim leads to disruptions in the payment timeline, resulting in delays for the provider awaiting reimbursement for services rendered.

In contrast to other scenarios, such as immediate processing or automatic extensions, the situation is primarily characterized by the repercussions on the payment timeline due to a lack of the necessary documentation or information needed for the claim to be processed efficiently. The claim being paid at a reduced rate is also not relevant, as that typically pertains to negotiation scenarios after a claim has been processed successfully and does not apply to the initial lack of claim receipt.