A completed insurance claim form submitted within the program time limit that contains all the necessary information without deficiencies so it can be processed and paid promptly.
A claim that does not require investigation or development outside the Medicare operation on a prepayment basis.
An insurance form that has been completely and accurately filled out in such a manner that the physician (or other health care provider) receives the maximum reimbursement allowed by the third-party payer that can be supported by the medical record. The claim form follows required guidelines; has no typographical or punctuation errors; all blocks contain the required data; and correct diagnostic (ICD-9) code(s) and procedure and service codes (CPT) are correctly documented. Bottom line: The claims processing office can pay the claim without delay or without having further contact with the submitting medical facility.