Medical Billing Terms C: Clean Claim, Claim Rejection and Clearinghouse Terms
A clean claim is a claim with no errors that a payer can process without extra information. This page defines the clean claim and the related terms from charge lag to CMS, including claim rejection, claim denial, claim scrubbing and clearinghouse. Each entry gives a plain definition, why it matters, an example, and an official source. MCM South Medical Billing Service, LLC works only in mental and behavioral health billing.
On this page (23 terms)
- Charge Lag
- CHIP (Children's Health Insurance Program)
- Cigna Healthcare
- Civil Monetary Penalties (CMP)
- Claim
- Claim Attachment
- Claim Denial
- Claim Form
- Claim Frequency Code
- Claim Rejection
- Claim Scrubbing
- Claim Status
- Claim.MD
- Clean Claim
- Clean Claim Rate
- Clearinghouse
- Clearinghouse Enrollment
- Clearinghouse Outage Contingency
- Clearinghouse Rejection
- Clinical Psychologist
- Clinical Psychologist (Medicare)
- Clinical Social Worker (Medicare)
- CMS (Centers for Medicare & Medicaid Services)
How to use these Clean Claim definitions
Use this page as a quick reference for Clean Claim, from Charge Lag to CMS. Each entry gives a plain definition, why it matters to a mental health practice, and an official source. When a rule changes by payer or state, the entry says so, so confirm Clean Claim details with the payer before you bill.
Checklist: put the clean claim definitions to work
- Charge Lag: Long lag delays billing and raises timely filing risk.
- CHIP (Children's Health Insurance Program): Rules vary by state, and some states run CHIP within Medicaid.
- Cigna Healthcare: Has its own network, authorization, and behavioral health arrangements.
- Civil Monetary Penalties (CMP): Penalties can be assessed per claim, so errors can add up. Compliance programs aim to prevent them.
Charge Lag
Also called days to charge entry; charge entry lag
- Definition
- The time between the date of service and when the charge is entered in the billing system.
- Why it matters
- Long lag delays billing and raises timely filing risk.
- Illustrative example
- A therapist finalizes notes five days after sessions.
Related termsDays in UnbilledTimely Filing
Reference sourceHFMAchecked 10/9/26
CategoriesRevenue Cycle Metrics
CHIP (Children's Health Insurance Program)
Also called CHIP; SCHIP
- Definition
- A federal and state program that covers children in families with incomes too high for Medicaid but who cannot afford private insurance.
- Why it matters
- Rules vary by state, and some states run CHIP within Medicaid.
- Illustrative example
- A child covered by CHIP receives therapy under state rules.
Related termsMedicaid
Reference sourceMedicaid.govCMS (Centers for Medicare & Medicaid Services)checked 10/9/26
CategoriesMedicare & Medicaid Terms
Cigna Healthcare
Also called Cigna; The Cigna Group
- Definition
- A national health insurer and part of The Cigna Group.
- Why it matters
- Has its own network, authorization, and behavioral health arrangements.
- Illustrative example
- A provider checks Cigna's provider site.
Related termsEvernorthBehavioral Health Carve-Out
Reference sourceCigna Healthcarechecked 10/9/26
CategoriesBCBS, UHC & Commercial Payer Terms
Civil Monetary Penalties (CMP)
Also called CMP; OIG civil monetary penalty
- Definition
- Civil monetary penalties are fines that OIG or other agencies can impose for certain violations of federal health care laws, such as submitting false claims or violating the anti-kickback statute.
- Why it matters
- Penalties can be assessed per claim, so errors can add up. Compliance programs aim to prevent them.
- Illustrative example
- A regulator alleges a pattern of upcoded claims and proposes a monetary penalty for each claim.
Related termsFalse Claims ActAnti-Kickback StatuteOverpaymentCompliance ProgramGuide: Fraud and abuse laws
Reference sourceHHS Office of Inspector General (OIG)checked 10/9/26
CategoriesAudits & Compliance
Claim
Also called health insurance claim; insurance claim; medical claim
- Definition
- A request for payment that a provider sends to a payer for services delivered to a covered member.
- Why it matters
- Every downstream metric, from denial rate to days in A/R, starts with a claim submitted correctly.
- Illustrative example
- A therapist submits a claim for a 53-minute session with the date of service, codes, and diagnosis.
Related termsClean ClaimClaim FormDate of Service (DOS)
Reference sourceCMS (Centers for Medicare & Medicaid Services)checked 10/9/26
CategoriesClaims Processing
Claim Attachment
Also called attachments; PWK; 275
- Definition
- Supporting documents sent with or after a claim, using electronic or paper methods.
- Why it matters
- Some claims require records to be paid.
- Illustrative example
- A payer requests notes to support a claim.
Related termsAdditional Documentation Request (ADR)Claim
Reference sourceX12checked 10/9/26
Claim Denial
Also called denied claim; claim denials
- Definition
- A claim the payer processed and refused to pay, for reasons such as medical necessity, eligibility, or coding, which can be appealed.
- Why it matters
- Denials require investigation and, often, an appeal or correction with a deadline.
- Illustrative example
- A claim is denied because the service was not authorized.
Related termsClaim RejectionAppealCARC (Claim Adjustment Reason Code)RARC (Remittance Advice Remark Code)
Reference sourceCMS (Centers for Medicare & Medicaid Services)checked 10/9/26
CategoriesDenials & Appeals
Claim Form
Also called claim forms; CMS-1500; UB-04
- Definition
- The standard form for submitting claims. The CMS-1500 is used for professional services and the UB-04 for institutional services, and each has an electronic equivalent.
- Why it matters
- Behavioral health practices bill professional services on the CMS-1500 or 837P.
- Illustrative example
- A therapist uses the CMS-1500 layout for paper claims and 837P for electronic.
Related termsCMS-1500UB-04 (CMS-1450)837P837I
Claim Frequency Code
Also called claim frequency type code; frequency code 7; frequency code 8
- Definition
- A code on a claim that shows whether it is original (1), replacement (7), or void/cancel (8), among others.
- Why it matters
- Using the right frequency code prevents duplicate denials.
- Illustrative example
- A corrected claim is sent with frequency code 7 and the original claim number.
Related termsCorrected ClaimReplacement ClaimVoid ClaimGuide: Corrected claims
Claim Rejection
Also called rejected claim; payer rejection
- Definition
- A claim returned unprocessed because of a format, data, or eligibility error; it must be corrected and resubmitted, and it does not start the appeal process.
- Why it matters
- Confusing a rejection with a denial wastes time on appeals when a correction is needed.
- Illustrative example
- A claim is rejected because the patient's date of birth does not match.
Related termsClaim DenialClearinghouse RejectionCorrected Claim
Reference sourceCMS (Centers for Medicare & Medicaid Services)X12checked 10/9/26
CategoriesClaims ProcessingDenials & Appeals
Claim Scrubbing
Also called claim scrubber; scrubber edits; claim edits
- Definition
- Automated checks that review claims for errors before they go to the payer, such as missing fields, invalid codes, or mismatched data.
- Why it matters
- Catching errors before submission reduces rejections and denials.
- Illustrative example
- A scrubber flags a missing rendering NPI before the claim is sent.
Related termsClearinghouseClaim RejectionFirst Pass Resolution Rate (FPRR)
Reference sourceX12checked 10/9/26
Claim Status
Also called claim status inquiry; 276/277
- Definition
- A request to a payer, by portal, phone, or electronic transaction, to learn where a submitted claim is in processing.
- Why it matters
- Regular status checks are part of A/R follow-up.
- Illustrative example
- A biller checks status on claims unpaid after the expected window.
Related terms276/277 Claim Status TransactionAccounts Receivable (A/R)A/R Follow-UpGuide: Claim status inquiry
Reference sourceX12checked 10/9/26
Claim.MD
Also called ClaimMD
- Definition
- A clearinghouse service for submitting claims and checking status. Listed for reference; not an endorsement or partnership.
- Why it matters
- Used by small practices and billing services.
- Illustrative example
- A biller uploads claims to Claim.MD.
Related termsClearinghouseClaim Scrubbing
Reference sourceClaim.MDchecked 10/9/26
CategoriesEDI & Clearinghouse Terms
Clean Claim
Also called clean claim rate; error-free claim
- Definition
- A claim with all required data, correctly formatted, that a payer can process without further information. Definitions of 'clean' for payment deadlines differ by law and contract.
- Why it matters
- Clean claims pay faster and drive first-pass resolution.
- Illustrative example
- A claim with correct member ID, NPI, and codes pays on first submission.
Related termsClaim ScrubbingFirst Pass Resolution Rate (FPRR)Prompt Pay Law
Reference sourceCMS (Centers for Medicare & Medicaid Services)checked 10/9/26
CategoriesClaims ProcessingRevenue Cycle Metrics
Clean Claim Rate
Also called clean claim percentage
- Definition
- The percentage of claims accepted and processed on first submission without needing correction.
- Why it matters
- Shows the quality of front-end processes.
- Illustrative example
- A practice sees 95% of claims accepted without correction.
Related termsFirst Pass Resolution Rate (FPRR)Claim ScrubbingClean Claim
Reference sourceHFMAchecked 10/9/26
CategoriesRevenue Cycle MetricsClaims Processing
Clearinghouse
Also called claims clearinghouse; EDI clearinghouse
- Definition
- A company that receives claims from providers, checks and reformats them, and routes them to payers, then returns status and remittance data.
- Why it matters
- Most claims pass through a clearinghouse, which can reject a claim before the payer sees it.
- Illustrative example
- A practice sends claims via a clearinghouse that forwards them to hundreds of payers.
Related termsClearinghouse RejectionPayer IDClaim ScrubbingElectronic Data Interchange (EDI)Guide: Clearinghouse enrollment
Reference sourceX12checked 10/9/26
Clearinghouse Enrollment
Also called payer enrollment through clearinghouse; EDI enrollment
- Definition
- Registering with a clearinghouse and, for many payers, completing payer-specific EDI setup so claims and remittances flow electronically.
- Why it matters
- Required before electronic claims for many payers.
- Illustrative example
- A practice completes EDI enrollment for claims and ERAs.
Related termsClearinghouseEFT EnrollmentGuide: Clearinghouse enrollment
Reference sourceX12checked 10/9/26
CategoriesEDI & Clearinghouse Terms
Clearinghouse Outage Contingency
Also called clearinghouse downtime plan; claim submission contingency
- Definition
- A plan for how a practice will submit claims, check eligibility, and receive payments if its clearinghouse or a major payer connection goes down. The February 2024 Change Healthcare cyberattack disrupted claims and payment flows across the industry.
- Why it matters
- Practices with a backup route recovered cash flow more easily.
- Illustrative example
- A practice keeps a second clearinghouse or payer portal access ready.
Related termsClearinghouseChange HealthcareRevenue Cycle Management (RCM)Guide: Clearinghouse enrollment
Reference sourceAmerican Hospital Association (AHA)checked 10/9/26
Clearinghouse Rejection
Also called front-end rejection; clearinghouse reject; 277CA rejection
- Definition
- A claim returned by the clearinghouse for failing format or data checks, before it is accepted by the payer.
- Why it matters
- Rejected claims are not denied; they never entered adjudication and must be fixed and resubmitted.
- Illustrative example
- A claim is rejected for an invalid subscriber ID and fixed and resent the same day.
Related termsClaim RejectionClaim Denial277CA Claim AcknowledgmentGuide: Clearinghouse enrollment
Reference sourceX12checked 10/9/26
Clinical Psychologist
Also called clinical psychology; PhD psychologist; PsyD; doctoral psychologist
- Definition
- A clinical psychologist is a licensed psychologist who provides assessment and treatment of mental health conditions, usually with a doctoral degree. The Society of Clinical Psychology, Division 12 of the American Psychological Association, is a professional home for the field.
- Why it matters
- Psychologists often bill psychotherapy and psychological testing codes. Payer credentialing and Medicare enrollment have specific rules for this license type.
- Illustrative example
- A psychologist bills 90837 for therapy and 96130 for a testing evaluation.
Related termsClinical Psychologist (Medicare)Psychological TestingPsychotherapistScope of Practice
Reference sourceSociety of Clinical Psychology (Division 12, American Psychological Association)CMS Medicare Learning Network (MLN)checked 10/9/26
CategoriesCredentialing & EnrollmentBehavioral Health Specific Terms
Clinical Psychologist (Medicare)
Also called CP Medicare; Medicare clinical psychologist; psychologist Medicare enrollment
- Definition
- For Medicare, a clinical psychologist is a psychologist licensed or certified at the independent practice level who directly provides diagnostic, assessment, preventive, and therapeutic services. CMS lists clinical psychologists among the practitioners who can bill Medicare for mental health services.
- Why it matters
- Enrollment and billing follow Medicare's provider type rules. A clinical psychologist can bill Medicare under their own NPI, and can reassign benefits to a group.
- Illustrative example
- A licensed psychologist enrolls in Medicare as a clinical psychologist and bills 90837 under their own NPI.
Related termsClinical Social Worker (Medicare)Marriage and Family Therapist (Medicare)Mental Health Counselor (Medicare)Medicare Enrollment (PECOS)
Reference sourceCMS Medicare Learning Network (MLN)CMS (Centers for Medicare & Medicaid Services)checked 10/9/26
CategoriesMedicare & Medicaid TermsCredentialing & Enrollment
Clinical Social Worker (Medicare)
Also called CSW Medicare; LCSW Medicare enrollment; Medicare clinical social worker
- Definition
- For Medicare, a clinical social worker generally needs a master's or doctoral degree in social work and at least two years or 3,000 hours of post-master's supervised clinical experience, plus state licensure or certification. CMS lists clinical social workers among the practitioners who can bill Medicare for mental health services.
- Why it matters
- Confirm you meet the definition before you enroll. Requirements can differ from your state license alone.
- Illustrative example
- An LCSW confirms the degree, hours, and license details before enrolling in Medicare.
Related termsClinical Psychologist (Medicare)Marriage and Family Therapist (Medicare)Mental Health Counselor (Medicare)Medicare Enrollment (PECOS)
Reference sourceCMS Medicare Learning Network (MLN)CMS (Centers for Medicare & Medicaid Services)checked 10/9/26
CategoriesMedicare & Medicaid TermsCredentialing & Enrollment
CMS (Centers for Medicare & Medicaid Services)
Also called CMS
- Definition
- The federal agency within HHS that runs Medicare and works with states on Medicaid and CHIP.
- Why it matters
- CMS publishes the rules, fee schedules, and manuals that many payers follow.
- Illustrative example
- A practice checks the CMS website for the fee schedule.
Related termsMedicareMedicaidMLN (Medicare Learning Network)
Reference sourceCMS (Centers for Medicare & Medicaid Services)checked 10/9/26
CategoriesMedicare & Medicaid Terms
No term on this page matches. Try another word, or use the glossary pages bar above.
Quick answer: Clean Claim
What is a clean claim?
Clean Claim is a claim with all required data, correctly formatted, that a payer can process without further information. Definitions of 'clean' for payment deadlines differ by law and contract. Clean claims pay faster and drive first-pass resolution.
Frequently asked questions: Clean Claim
What is a claim rejection?
Claim Rejection is a claim returned unprocessed because of a format, data, or eligibility error; it must be corrected and resubmitted, and it does not start the appeal process. Confusing a rejection with a denial wastes time on appeals when a correction is needed.
What does a clearinghouse do?
Clearinghouse is a company that receives claims from providers, checks and reformats them, and routes them to payers, then returns status and remittance data. Most claims pass through a clearinghouse, which can reject a claim before the payer sees it.
What is claim scrubbing?
Automated checks that review claims for errors before they go to the payer, such as missing fields, invalid codes, or mismatched data. Catching errors before submission reduces rejections and denials.
Related resources
Where MCM South works
MCM South serves psychotherapists and psychiatrists in ten states: Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois.
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