Clean Claims means claims that may be processed without obtaining additional information from the subcontracted provider of care, from a noncontracting provider or from a third party but does not include claims under investigation for fraud or abuse or claims under review for medical necessity.

Clean Claims means a claim submitted that has no defect, impropriety, or particular circumstance requiring special treatment preventing payment. If We have not received the information We need to process a claim, We will ask for the additional information necessary to complete the claim. You will receive a copy of that request for additional information, for Your information. In those cases, We cannot complete the processing of the claim until the additional information requested has been received. We will make Our request for additional information within 30 days of Our initial receipt of the claim and will complete Our processing of the claim within 15 days after Our receipt of all requested information. Claims submitted by Providers are also governed by Indiana Code § 27-13-36.2.

Clean Claims. A truthful, complete and accurate claim. A claim that does not have to be returned for additional information.

Examples of Clean Claims in a sentence

BCBSM will process Provider's Clean Claims submitted in accordance with this Agreement in a timely fashion.
Claims under investigation for Fraud or Abuse or under review to determine if they are Medically Necessary are not Clean Claims.
Health Plan shall ensure that Clean Claims are adjudicated promptly in accordance with applicable statutory and regulatory requirements.
Alliant will evaluate Clean Claims to ensure that the charges are correct and proper, billed using the most accurate and appropriate Current Procedural Terminology (CPT), International Classification of Diagnosis (ICD), Healthcare Common Procedure Coding System (HCPCS) and Revenue codes, and if applicable, documented in the medical records.
Health Plan shall pay or deny Clean Claims within the time period set forth in Attachment C.

More Definitions of Clean Claims

Clean Claims means a properly completed claim for payment for Designated Covered Services received by THP from Agent or Provider that, in the determination of the Designated Paying Agent, is complete (i.e., requires no further information, documentation, adjustment or alteration by Provider in order to be processed or paid), that is not contested or denied by the Designated Paying Agent (i.e., not reasonably believed to be incorrect or fraudulent) and that is not subject to appeal or grievance procedures.

Clean Claims means a request for payment for Covered Services submitted by a Participating Provider or his/her designee on a HCFA 1500 form (or successor form), or the electronic equivalent of this form when billing claims electronically, that contains all of the elements consistent with claims processing rules described under 28 TAC 21.2801 through 21.2816 “Submission of Clean Claims” of the Texas Department of Insurance as they may, from time to time, be revised.

Clean Claims. A Claim received by the Contractor for adjudication, which can be processed without obtaining additional information from the Provider of the service or from Third Party, as provided in Section 22.4.5.1. It includes a claim with errors originating in the Contractor's claim system. It does not include a claim from a Provider who is under investigation for Fraud or Abuse, or a claim under review for Medical Necessity.

Clean Claims means a claim that meets the industry standards for completeness and accuracy, is not materially deficient, and includes among other items the International Classification of Disease (ICD), Current Procedural Terminology (CPT) and/or revenue codes, itemized claim detail, and the costs associated.

Clean Claims means a claim submitted by you or a provider that has no defect, impropriety, or particular circumstance requiring special treatment preventing payment. If we have not received the information we need to process a claim, we will ask for the additional information necessary to complete the claim. You will receive a copy of that request for additional information. In those cases, we cannot complete the processing of the claim until the additional information requested has been received. We will make our request for additional information within 30 days of our initial receipt of the claim and will complete our processing of the claim within 15 days after our receipt of all requested information.

Clean Claims means claims that can be processed by the Department without obtaining additional information from the Contractor.