What defines a clean claim in Resolute, and why is it critical?

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Multiple Choice

What defines a clean claim in Resolute, and why is it critical?

A clean claim is one that includes all required data fields and uses the correct, current codes. In Resolute, this means every piece the payer needs is present—patient and provider identifiers, dates and place of service, diagnosis codes, procedure codes (with appropriate modifiers), charges, and payer details—formatted and submitted according to the system and payer rules. When a claim is complete and properly coded, adjudication can happen on the first pass, which reduces denials and speeds payment. This completeness also minimizes the need for resubmissions or clarifications, improving cash flow. Using up-to-date codes and aligning diagnoses with the corresponding procedures prevents common denials tied to coding errors, whereas missing fields or incorrect coding trigger edits and delays.

A clean claim is one that includes all required data fields and uses the correct, current codes. In Resolute, this means every piece the payer needs is present—patient and provider identifiers, dates and place of service, diagnosis codes, procedure codes (with appropriate modifiers), charges, and payer details—formatted and submitted according to the system and payer rules. When a claim is complete and properly coded, adjudication can happen on the first pass, which reduces denials and speeds payment. This completeness also minimizes the need for resubmissions or clarifications, improving cash flow. Using up-to-date codes and aligning diagnoses with the corresponding procedures prevents common denials tied to coding errors, whereas missing fields or incorrect coding trigger edits and delays.

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