A billing and coding specialist submitted a claim to Medicare electronically. No errors were found by the billing software or clearinghouse. Which describes this claim?

A billing and coding specialist submitted a claim to Medicare electronically. No errors were found by the billing software or clearinghouse. Which describes this claim?

• A. Clean claim
• B. Denied claim
• C. Fraudulent claim
• D. Duplicate claim

Answer: (A)

A clean claim is a submission that contains all required information with accurate data and no errors that would block processing. When the billing software and clearinghouse flag nothing, the claim has passed automated edits and is ready for adjudication by the payer. It means the patient and provider details are correct, codes are valid, and the claim is complete. Even though it’s clean, payment still depends on the payer’s coverage rules and medical necessity. A denied claim would indicate the payer found an issue after review, a fraudulent claim involves intentional misrepresentation, and a duplicate claim is a repeated submission for the same service that would typically be detected by the system.

A clean claim is a submission that contains all required information with accurate data and no errors that would block processing. When the billing software and clearinghouse flag nothing, the claim has passed automated edits and is ready for adjudication by the payer. It means the patient and provider details are correct, codes are valid, and the claim is complete. Even though it’s clean, payment still depends on the payer’s coverage rules and medical necessity. A denied claim would indicate the payer found an issue after review, a fraudulent claim involves intentional misrepresentation, and a duplicate claim is a repeated submission for the same service that would typically be detected by the system.