New York state insurance regulators are trying to give doctors, hospitals and health carriers a clearer definition of what constitutes a clean claim.[@@]
The regulators have adopted an emergency regulation that lists what information providers and their patients must provide when filling out 2 popular standard claim forms.
The regulation, Regulation 178, lists the essential fields on the CMS 1500 claim form and the HCFA 1450 claim form. The essential fields include the fields that ask about matters such as the patient’s name, address, birth date, place of service and diagnosis code.
New York lawmakers enacted a health claim prompt-payment law back in 1997. The law requires carriers to pay “clean claims” quickly, unless insurers have reasons to suspect fraud or have some other good reasons to ask for more information.