Greetings!
You hear about clean claims all the time. What is a clean claim? It is a claim that does not contain a defect requiring the payer to investigate prior to adjudication. The best grade for a clean claim outcome is 90% or better. It is one of the primary measurements of revenue cycle integrity.
Tips to Achieve the Best Grade
- Measure clean claim ratio daily
- Measure clean claim monthly average
- Record clean claim percentage
- Define, report and act on claim error problems
- Create edits to accurately resolve claim errors
- Assign ownership to responsible departments
- Educate and communicate with billing staff
- Worklists accessed, utilized, and monitor daily
- Inventory all electronic claims
- Validate claim payer acceptance
- Monitor progress
- Report clean claim progress
- Acknowledge success
- Communicate and communicate more
Cirius Clean Claim-Denial Prevention Report |
Tips to Achieve the Best Grade with Cirius
Ability to define claim error data in real time
Control and drive the creation of provider specific edits
Ownership assignments establishing accountability at originating department
Real-Time delivery of updated payer edits
Auto-Fix or corrective claim editing by user-Change data today and increase urgency of accuracy levels
References documented on each standard delivered edit from the originating payer source websites
Hold claims standard or custom categorized codes
Overlap claims identified and fixed prior to bill touch
Worklists slice and dice claim workload
Reports provide instantaneous measurements
Production standard dashboard measurements
Automate secondary claims with built in edits
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