File an Accurate Clean Claim

Enter Accurate Data in the Correct Location

  • Check with each insurance payer to determine what data is required.
  • Ensure that all data is entered correctly and accurately in the correct fields.
  • For UB-04: Most instructions for inpatient and outpatient services are the same. See the Uniform Billing Guide for specific details.
  • Enter insurance information including the patient’s name exactly as it appears on the insurance card.
  • Use correct diagnosis codes (ICD-9 or upcoming ICD-10) and procedure codes (CPT/HCPCS) using modifiers when required.
  • Use only the physical address for the service facility location field.
  • Don’t forget to include NPI information where indicated.

Include Proper Documentation

Sometimes paper billing requires proper documentation to be mailed with the claim form.

  • Itemized statement
  • Medical history or medical records
  • Primary payer explanation of benefits
  • Proof of accident, injury or incident

File a Clean Claim

A clean claim is one that is accurately completed in accordance with the insurance companies and federal government’s billing guidelines. Since billers are the last hands that touch a medical claim, they are responsible for making sure that it goes out clean. Submitting a clean claim is the only way to guarantee correct payment the first time.

Medical office managers can do their part in making the billers job a little easier in several ways.

  • Purchasing real-time benefits verification software can save precious time by verifying a patients insurance information at check-in time.
  • Upgrade your old paper-based medical record system to the electronic health record (EHR).
  • Keep the billing software pre-billing claim checks up-to-date with health care industry changes for billing, coding and information specific to certain payers allowing staff to make proper corrections.