Which statement describes a clean claim's characteristics?

Which statement describes a clean claim's characteristics?

• A. No errors detected by payer systems
• B. Contains billing errors
• C. Requires manual resubmission
• D. Is never accepted

Answer: (A)

A clean claim is one that can flow through payer processing without automatic edits or manual intervention. It contains complete and correct information—patient and provider details, valid CPT/HCPCS and ICD-10-CM codes with any required modifiers, accurate dates of service, place of service, and other data as required by the payer. When all data align with the payer’s edits, no errors are detected, allowing automatic adjudication and faster payment. If there are missing fields, invalid or mismatched codes, incorrect dates, or other data problems, the payer flags errors and the claim becomes a dirty claim that often requires corrections and resubmission. A clean claim being accepted as such is not a guarantee of payment, but it means the claim can be processed without edits or manual review, which is why the statement describing a clean claim is that no errors are detected by payer systems. The other options describe outcomes that would indicate problems with the claim—billing errors, the need for manual resubmission, or rejection—which are not characteristic of a clean claim.

A clean claim is one that can flow through payer processing without automatic edits or manual intervention. It contains complete and correct information—patient and provider details, valid CPT/HCPCS and ICD-10-CM codes with any required modifiers, accurate dates of service, place of service, and other data as required by the payer. When all data align with the payer’s edits, no errors are detected, allowing automatic adjudication and faster payment.

If there are missing fields, invalid or mismatched codes, incorrect dates, or other data problems, the payer flags errors and the claim becomes a dirty claim that often requires corrections and resubmission. A clean claim being accepted as such is not a guarantee of payment, but it means the claim can be processed without edits or manual review, which is why the statement describing a clean claim is that no errors are detected by payer systems.

The other options describe outcomes that would indicate problems with the claim—billing errors, the need for manual resubmission, or rejection—which are not characteristic of a clean claim.