What Payers Don’t Want You To Know About Clean Claim Laws

Oct

10th

What Payers Don’t Want You To Know About Clean Claim Laws

Files under how to | Posted by Carl Mays II

by Carl Mays II

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. To which insurance companies does your state’s clean claim law apply (some payers are exempt);

2. The date the clean claim “clock” begins (i.e., the claims submission date),

3. Events that stop the clean claim clock (e.g., an information request from the payer),

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.

Planning and constructing the monitoring system can be difficult, but it can have a significant impact on how quickly your claims are paid cleanly. Aggressive users of clean claim laws have actually received calls from payers assuring them that their claims will be process quickly and requesting that complaints be held to give the payer a chance to prove itself.

If you would like to better understand the benefits of implementing a Clean Claim Law tracking system before investing the time and energy into the design and implementation of the system, then run a pilot. Identify a payer that is consistently in violation of the Clean Claim Law. Select 30 to 50 claims from this payer and manually track all of the items outlined above. Once you have some violations, file a report following your state’s guidelines. This process will allow you to better understand what will be required to make such a system a permanent part of your medical billing and see the potential benefit to your practice.

About the Author:

Carl Mays II, President of ClaimCare Medical Billing Services, has spent over 14 years improving the financial performance of his clients. To read more about selecting Healthcare Billing Services see his other articles.