What is a clean claim?
A clean claim is one the payer can process as sent: right client, right dates, right service code and modifier, an active authorization, and no missing fields. It needs no extra research or paper. Clean claims move faster and are the ones payment-time rules are written around.
A clean claim has everything the payer needs to say yes or no right away. Nobody has to call you, look something up, or wait for a paper attachment.
A claim is usually clean when:
- The client was eligible on every date billed.
- The authorization covers those dates and units.
- The service code and modifier match the billing rule.
- Your provider ID matches the one on the authorization.
- For personal care, the visit data from EVV is attached, because Georgia denies EVV-required claims without it.
- Other insurance was billed first when it applies, since Medicaid pays last.
If something is missing, the claim is rejected or denied and the clock keeps running against your filing deadline.
Federal rules link payment speed to clean claims. They say what share of clean claims a state must pay within 30 and 90 days. That is why one wrong modifier costs more than the few minutes it takes to fix.
The habit that helps most is to check each claim against the authorization and the visit record before sending.
How CareBravo® helps
The claim is built from checked shifts, so the visit data is already attached before anything is sent.
Sources
- Georgia Medicaid Common Denials webinar (Feb 2021) · Georgia DCH / GAMMIS
- Electronic Visit Verification (EVV): Provider-related FAQs · Georgia DCH
- 42 CFR 447.45 Timely claims payment · eCFR / U.S. Government
Reviewed by Beth Bledsoe, Care Business Advisor®, 28 Oct 2026. Rules change. Confirm with your state Medicaid agency before you act.
How CareBravo’s Billing agent handles this
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