Clean claim means a claim that can be processed without obtaining additional information from the provider or from a third party, including invoices that meet DHCS established billing and invoicing requirements.

A clean claim is a claim that has no defect or impropriety, including lack of required substantiating documentation for non-participating providers and suppliers. The member's name, identification number, physician name(s), date of service (DOS), diagnosis code(s), and billed amount among, but not all, the required elements to process the claim.

Emergency services, out-of-area urgently needed services, and out-of-area renal dialysis do not require prior authorization to be considered as a clean claim.

Clean claim means a claim that can be processed without obtaining additional information from the provider or from a third party, including invoices that meet DHCS established billing and invoicing requirements.

A clean claim is a claim that has no defect or impropriety, including lack of required substantiating documentation for non-participating providers and suppliers. The member's name, identification number, participating physician group (PPG) and physician names, date of service (DOS), diagnosis code(s), and billed amount are among, but not all, the required elements to process the claim.

Emergency services, out-of-area urgently needed services, and out-of-area renal dialysis do not require prior authorization to be considered as a clean claim.