What does the term "clean claim" mean?

The term "clean claim" refers to a claim that is submitted without any errors or omissions and contains all the necessary information for processing. When a claim is clean, it means that it has been accurately filled out with the correct patient details, appropriate codes for diagnosis, and any other required documentation. This completeness and accuracy facilitate timely payment from payers, as the claim can be processed without delays or the need for additional information.

In the context of pharmacy billing, ensuring claims are clean is crucial because any discrepancies may lead to denials, resubmissions, or delayed payments, which can have significant impacts on cash flow for pharmacies. A clean claim streamlines the billing process, enhances revenue cycle efficiency, and ultimately supports sustainability in healthcare practices.