Final answer:
A clean healthcare claim is one that is error-free and accepted for processing by the payer. It must meet certain criteria, such as having accurate and complete information. Clean claims help ensure timely payment for healthcare providers.
Step-by-step explanation:
A clean healthcare claim is one that is error-free and is accepted for processing by the payer. A healthcare claim is a request for payment from a healthcare provider to an insurance company. In order for a claim to be accepted and processed by the payer, it must meet certain criteria, such as having accurate and complete information, including the patient's demographic information, diagnosis codes, and procedure codes.
For example, if a patient visits a doctor and has a insurance plan with a deductible, the doctor's office will submit a claim to the insurance company for reimbursement. If the claim is complete and error-free, the insurance company will accept it for processing and review the information to determine the amount of reimbursement.
It is important for healthcare providers to submit clean claims in order to receive timely payment and avoid delays in reimbursement. Clean claims help streamline the billing and payment process, ensuring that healthcare providers are paid for the services they provide.