All 50 states currently have a Clean Claim Law. The effectiveness of the laws varies dramatically ranging from South Dakota which provides for no financial penalty to Texas where the penalty can go up to a requirement on the payer to pay billed charges; that's right billed charges.
The basic idea of the law is that a payer has to respond to a clean claim within a set time (usually around 30 days for electronic claims). In order to utilize the clean claim law effectively you must have a tracking system built into your medical billing process that flags:
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. Events that restart the clean claim clock (e.g., your office replies to a payer's information request), and
5. The date when you received the payer's final adjudication decision.
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.
One way to quickly get started using the clean claim law is to run a trial on a payer that you feel consistently takes more than 30 days to ajudicates claims. Find a small number of large claims for this payer that have gone past 30 days and then conduct a trial run with those claims. This will allow you to learn the fundamentals of how to submit and monitor complaints and see the results of your complaints.
Copyright 2006 by Carl Mays II - 15275
The basic idea of the law is that a payer has to respond to a clean claim within a set time (usually around 30 days for electronic claims). In order to utilize the clean claim law effectively you must have a tracking system built into your medical billing process that flags:
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. Events that restart the clean claim clock (e.g., your office replies to a payer's information request), and
5. The date when you received the payer's final adjudication decision.
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.
One way to quickly get started using the clean claim law is to run a trial on a payer that you feel consistently takes more than 30 days to ajudicates claims. Find a small number of large claims for this payer that have gone past 30 days and then conduct a trial run with those claims. This will allow you to learn the fundamentals of how to submit and monitor complaints and see the results of your complaints.
Copyright 2006 by Carl Mays II - 15275
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 learn more about selecting Healthcare Billing Services subscribe to Carl's blog
