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. The date your practice initially submits each medical claim;
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. When you received a payment or denial.

The design and implementation of the system and reporting can be challenging, but it can pay huge dividends in terms of the penalties from payers and in the way in which you will make payers take notice of your claims next time. You may actually find, as have other aggressive users of the clean claim law, that you will receive calls from payers assuring you they will process your claims quickly and asking you to please stop submitting complaints.

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.

To learn how Cardiology Billing Partners can help you leverage your state's clean claim law please visit our website.

Copyright 2008 by Cardiology Billing Partners