A clean claim is simply the one that is submitted with every detail input correctly and verified to ensure zero errors. This means it’s been checked by various members for errors and sent for reimbursement with all of the necessary documentation without missing any detail. While this may seem like a no-brainer, approximately 80% of all medical claims are submitted with some type of error, usually billing. Other issues include missing explanations of benefits (EOBs), or incomplete/incorrect identifying or insurance information from the patient.
This, of course, causes the claim to be rejected by the insurer, which hurts both the patient (who is waiting to find out what their financial responsibility is) and the provider (who needs that reimbursement to keep revenue cycling smoothly through their practice).