Highmark Clean Claim Guidelines For Providers Highmark Clean Claim is defined as a claim with no defect or impropriety and one that includes all the substantiating documentation required to process the claim in a timely manner. The core data required on a claim to make it clean are outlined in this section and the next … Read More →
Electronic Claims Notes: Coordination of Benefits, Clean Claim, Claims Reimbursement Electronic Claims Notes given in the blog refer to Coordination of Benefits, Clean Claim, Claims Reimbursement guidelines for Health Plan of San Joaquin payers. Coordination of Benefits (COB) When HPSJ or the employer-sponsored plan of an SJHA client is the secondary payer, all claims must be submitted within 365 … Read More →
Clean Claims And Rejections (Upfront Rejections vs. Denials) Clean Claims are a type of a claim that does not require external investigation or development to obtain information not available on the claim form or on record in the health plan’s systems in order to adjudicate the claim. Clean claims must be filed within the timely filing period. … Read More →
EDI Claims Processing Notes For Security Health Plan Providers: Submission Reminder, Clean Claim Definition and Interest EDI Claims Processing guidelines given in today’s post refer to health care claim transactions sent to Security Health Plan. Find additional requirements to Claim Submission Reminder, Clean Claim Definition and Interest below. Claim Submission Reminder Security Health Plan follows Medicare claims submission guidelines. … Read More →