Clean Claim Laws are currently in place in every state. The assistance provided by the laws ranges from states like South Dakota which has no economic penalty to Texas where the payer sometimes is required to pay billed charges
Clean Claim laws can be a powerful medical billing tool because they are built upon the concept that insurance companies have a responsibility to quickly adjudicate clean claims. The typical law provides 30 days for a payer to process a clean electronic claim. To properly benefit from Clean Claim laws a medical billing company or medical practice must be capable of reliably and systematically keeping track of:
1. Which payers are subject to the clean a claim law (not all are),
2. The date the clean claim "clock" begins (i.e., the claims submission date),
3. Any events that legitimately give the payer more time to process the claim (for instance, a request for additional information);
4. When your practice has taken actions in response to payer requests;
5. The date from the payer's communication about the final disposition of the claim.
The idea of systematically tracking all of this information may be daunting, but with a smart system design it is possible and most definitely a worthwhile undertaking. After submitting a few Clean Claim law violation reports you will see your claims pay faster. I have seen situations where payers have actually called just to assure the practice that claims will be quickly processed.
If you would like to better understand the benefits of implementing a Clean Claim Law tracking system before investing the time and energy into the design and implementation of the system, then run a pilot. Identify a payer that is consistently in violation of the Clean Claim Law. Select 30 to 50 claims from this payer and manually track all of the items outlined above. Once you have some violations, file a report following your state's guidelines. This process will allow you to better understand what will be required to make such a system a permanent part of your medical billing and see the potential benefit to your practice.
Copyright 2006 by Carl Mays II - 15266
Clean Claim laws can be a powerful medical billing tool because they are built upon the concept that insurance companies have a responsibility to quickly adjudicate clean claims. The typical law provides 30 days for a payer to process a clean electronic claim. To properly benefit from Clean Claim laws a medical billing company or medical practice must be capable of reliably and systematically keeping track of:
1. Which payers are subject to the clean a claim law (not all are),
2. The date the clean claim "clock" begins (i.e., the claims submission date),
3. Any events that legitimately give the payer more time to process the claim (for instance, a request for additional information);
4. When your practice has taken actions in response to payer requests;
5. The date from the payer's communication about the final disposition of the claim.
The idea of systematically tracking all of this information may be daunting, but with a smart system design it is possible and most definitely a worthwhile undertaking. After submitting a few Clean Claim law violation reports you will see your claims pay faster. I have seen situations where payers have actually called just to assure the practice that claims will be quickly processed.
If you would like to better understand the benefits of implementing a Clean Claim Law tracking system before investing the time and energy into the design and implementation of the system, then run a pilot. Identify a payer that is consistently in violation of the Clean Claim Law. Select 30 to 50 claims from this payer and manually track all of the items outlined above. Once you have some violations, file a report following your state's guidelines. This process will allow you to better understand what will be required to make such a system a permanent part of your medical billing and see the potential benefit to your practice.
Copyright 2006 by Carl Mays II - 15266
About the Author:
Carl Mays II, President of ClaimCare Medical Billing Services, has spent the past 15 years enhancing the operations of his clients. To read more about selecting Healthcare Billing Services see his other articles.
