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Business Outsourcing Use the Clean Claim Law to Get Your Payers' Attention
Business Outsourcing Use the Clean Claim Law to Get Your Payers' Attention
| Use the Clean Claim Law to Get Your Payers' Attention |
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| Written by Carl Mays II |
| Friday, 17 October 2008 08:37 |
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Each state has passed a Clean Claim Law. The level of benefit these laws provide to medical practices and facilities starts on the low end with states such as South Dakota that provide little more than a slap on the insurance company's wrist to states such as Texas which levy substantial financial penalties on tardy payers. Clean Claim laws can be a powerful medical billing tool because they are built upon the concept that insurance companies have a responsibility to quickly adjudicate clean claims. The typical law provides 30 days for a payer to process a clean electronic claim. To properly benefit from Clean Claim laws a medical billing company or medical practice must be capable of reliably and systematically keeping track of: 1. To which insurance companies does your state's clean claim law apply (some payers are exempt); 2. When a claim was submitted, 3. When a request for information was received from the payer (if you receive one then it stops the 30 day clock until you respond), 4. Events that restart the clean claim clock (e.g., your office replies to a payer's information request), and 5. The date from the payer's communication about the final disposition of the claim. The idea of systematically tracking all of this information may be daunting, but with a smart system design it is possible and most definitely a worthwhile undertaking. After submitting a few Clean Claim law violation reports you will see your claims pay faster. I have seen situations where payers have actually called just to assure the practice that claims will be quickly processed. A quick way to get started with using the clean claim law is to pick a specific payer that you believe habitually delays claims beyond 30 days. Find a handful of claims that have gone past 30 days and then test the water with those claims. This will allow you to learn the basics of using the on-line tool provided for submitting complaints and see the impact of your initial complaints. Copyright 2006 by Carl Mays II About the Author: Carl Mays II, CEO of ClaimCare Medical Billing Services, has spent over 14 years improving the operations of his clients. To read more about what to look for in Healthcare Billing Services subscribe to Carl's blog Kindly provided by MoneyHunter.org You are welcome to use this article on your own website, if you include the link just before this text. |
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