Clean Claim

 

The clean claim comprises the payment of the medical bills for the health services, health equipment, home health care etc., in short it comprises all the facilities provided to the patients in their illnesses. The health care providers according to the health plan make appropriate bill in which they claim for the above services and facilities which is actually call clean claim.

The submission of clean claim means billing done by the health care provider for the services within one year after the date of service or the date of discharge of the particular patient. It is either submitted in writing or electronically.

There are various reasons regarding the submission of clean claims:

  • It provides original bills in which each and every information is mentioned.
  • Through this the customer can proofread the bills correctly.
  • If the claims do not get paid within 45days then the health providers will impose a penalty of simple interest of 12 per cent per annum on the bill.
  • If the insurance company or the customer refuses to pay the bill then the health providers also have the right to go to the court with their claims.

Generally the health insurance is an agreement between the customer and the insurance company. The health care provider is like a third party. In order to get their bill paid, there is a need of concrete evidence or claim regarding the health services and facilities that have been provided to the patients.

According to Department of Insurance and Financial services, the companies do not consider the complaints of the providers regarding the medical bills. the problems of the providers for not getting their payments timely were very common that is the under the Public Act 316 of 2002, the clean claim came into existence which provides an opportunity to the health care providers to claim for their bills.

If the clean claim is not submitted within one year of the date of service or date of discharge then the health care providers possess not right to demand for any payment from the customers. If the health care providers do not submit the clean claim timely, then it will cause a huge financial lose as consequence.

So from the above discussion it can be concluded that clean claim are meant for the health care providers to get the bill paid on time. This is like a document in which they have the right to claim for the services, equipment and facilities that they have provided to the patient during their illnesses. Apart from this there is also provision for getting interest if the payment is delayed. Thus clean claim is very helpful in resolving the financial issues between the health insurance company, customer and the health care provider.

Reference:

Anonymous, (2001).Clean Claims and Other Information for Health Providers,

Department of Insurance and Financial Services, retrieved from http://www.michigan.gov/difs/0,5269,7-303-12902_35510-263283–,00.html