Use Clean Claim Laws to Make Payers Actually Pay
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. When a request for information was received from the payer (if you receive one then it stops the 30 day clock until you respond),
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.
A quick way to get started with using the clean claim law is to pick a specific payer that you believe habitually delays claims beyond 30 days. Find a handful of claims that have gone past 30 days and then test the water with those claims. This will allow you to learn the basics of using the on-line tool provided for submitting complaints and see the impact of your initial complaints.
Copyright 2006 by Carl Mays II
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