Medical Billing and Coding Specialist how-to
How to Submit a Clean Claim
A clean claim is accepted and processed on the first submission: the fastest way to get paid.
A clean claim is accepted and processed on the first submission: the fastest way to get paid. In short: verify; confirm; enter, then complete the remaining steps below.
Step by step
Verify the patient’s demographics and insurance eligibility before the visit.
Confirm the provider’s documentation supports every code billed.
Enter diagnosis codes, procedure codes, modifiers and diagnosis pointers correctly.
Check the place of service, rendering provider NPI and dates of service.
Run claim scrubber edits and fix any errors.
Submit electronically through the clearinghouse and review the acceptance report.
Safety reminders for medical billing and coding specialists
- Protect patient information under HIPAA: access only what you need for your job
- Never upcode or bill for services not documented; this can constitute fraud
- Lock your screen and secure your home workspace if remote
- Report suspected compliance problems through proper channels
Key terms
ICD-10-CM · CPT · HCPCS Level II · Modifier · CMS-1500 · UB-04: see the full medical billing and coding specialist glossary.