The Elements of a Clean Insurance Claim

Posted by Team PracticeForces on Dec 9 2014

Fotolia_53662112_Subscription_Monthly_MI believe it’s fair to say that most physicians would like nothing more than to dedicate the vast majority of their time to patient care and clinical treatment. After all, isn’t helping patients in your medical specialization the No. 1 reason you became a doctor in the first place? Unfortunately, dealing with insurance companies on a daily basis takes up more of your valuable time as healthcare professionals.

Most of you have certainly experienced insurances denials and have allocated resources to be able to handle these issues when they arise. Still, we understand just how frustrating insurance denials can be when you run a specialty practice.

The most efficient way to address insurance matters in your specialty practice is to file a valid insurance claim. I know – at this point you are probably having a “duh” moment. Filing a clean insurance claim might sound like the no-brainer, but many healthcare professionals don’t put enough emphasis on absolutely making sure that the insurance claims they file are free of errors. The vast amount of insurance paperwork and minutiae is tedious enough to drive anyone crazy.

So, in this blog post, we are going to explain the elements of a clean insurance claim and what it means for the speed and efficiency of your claim acceptance (and reimbursement).

What is a “clean” insurance claim?

The elements of a clean insurance claim consist of a standard insurance form with all of the pertinent data filled out, including any relevant additional elements and attachments on the medical case/treatment. A clean claim is free of missing information, errors, defects or impropriety. In other words, the paperwork provides 100% complete and correct information about circumstances of the claim, preventing the possibility of a long back-and-forth, delay or flat-out denial from the insurance carrier.

Hospitals and other inpatient medical facilities submit UB-04 forms for inpatient procedures, whereas physician private practices and outpatient medical facilities use CMS-1500 forms for clinical treatment and outpatient procedures. Medical documents (e.g. treatment records) can also be requested by the insurance carrier for review.

A few things to keep in mind for clean insurance claims:

Clean insurance claims require strong attention to even the smallest of details. When you use EMR/EHR software to submit your insurance claims electronically, check for accuracy, keep, and file all transmission reports for your records. Stay on top of all claims submitted through a clearinghouse to ensure that they were processed and transmitted to their insurance carrier(s). Your computer software should follow clean claims guideline and correctly print the CMS-1500 form. Consult with your computer software vendor to verify that your EMR is up-to-date and doing its job.

If you use hard copies for your insurance forms, only use the original forms printed clearly and darkly in red ink, and refrain from folding these forms. Print all of your information on the forms in UPPERCASE letters as opposed handwriting the information in. This allows for consistency and legibility across the  boards. Further, don’t add punctuation or decimals, unnecessary attachments, stickers, staples, paperclips, post-it notes. And don’t highlight your claims with markers.

What PracticeForces can do for you to ensure that your insurance claims are clean and accepted quickly.

Take the insurance burden off of your shoulders by outsourcing your medical billing and revenue  management to PracticeForces. We will generate the insurance claims for you and use insurance claim  scrubbing techniques to verify that everything is clean, rectifying coding and informational errors as they come up. At PracticeForces, electronic claims are “cleansed” of any defects and transmitted within 12  hours of your patient’s visit.

We work quickly to make sure you receive a timely reimbursement. Using our services, you will get claim  status verification within one to two days of your initial insurance claim submittal. More importantly, we guarantee a 95% claims-acceptance rate, with over 96% of claims processed in less than three weeks. For more information on how PracticeForces can help you with your insurance claims and paperwork, contact us at 866-634-6327 now!


Download this Ebook

Topics: Medical Claims

Subscribe to Email Updates

Recent Posts

Posts by Topic

see all