Non-Clean Claim (Louisiana Healthcare Connections)
A non-clean claim is defined as a submitted claim that requires further investigation or development beyond the information contained in the claim. The errors or omissions in the claim may result in:
- A request for additional information from the provider or other external sources to resolve or correct data omitted from the claim
- The need for review of additional medical records
- The need for other information necessary to resolve discrepancies In addition, non-clean claims may involve issues regarding medical necessity and include claims not submitted within the filing deadlines.
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