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Clean Claim & Denial Prevention Checklist

Walk through eligibility, authorization, coding, and timely-filing checks before you submit a claim, and print a readiness summary.

Educational checklist, not a claim scrubber. It does not check real claims and cannot guarantee acceptance or payment. Confirm payer-specific rules with the payer. Never enter patient information.

Claim Readiness Summary — All State RCM
Prepared . Educational checklist only; not legal, payer, or coding advice.

1. Patient and eligibility

Coverage and demographic mismatches are a common reason claims are rejected or denied.

2. Authorization and referral

Requirements differ by payer, plan, and service.

3. Coding and documentation

The coding denial prevention reference linked below explains the reasoning behind these checks.

4. Claim data

Small data errors can stop an otherwise correct claim.

5. Timely filing and follow-up

Filing and appeal deadlines are set by each payer and contract. This checklist does not state them.

6. Behavioral health considerations (if you bill these services)

Behavioral health billing often has extra plan-specific rules. Confirm each with the payer.

Your progress

0 of 30 items checked 0%

Not started

Still to check

    Common claim problem categories

    • Eligibility and coverage: Inactive coverage, wrong payer, or services outside the benefit.
    • Authorization and referral: Missing, expired, or mismatched authorization.
    • Coding and modifiers: Invalid or unsupported codes, or modifier and edit conflicts.
    • Claim and demographic data: Mismatched names, member IDs, provider identifiers, or dates.
    • Duplicates: Resubmitting a service that is already on file or in process.
    • Timely filing: Submitting or appealing after the payer’s deadline.
    • Provider enrollment: Rendering provider not enrolled or credentialed for that payer or date.

    How this checker works and its limits

    • Readiness = items checked ÷ total items. Every item counts equally.
    • It is a reminder list. A high percentage does not mean a claim will be accepted or paid.
    • It does not state payer-specific rules, code rules, or deadlines. Those vary and must be confirmed with the payer and your contracts.
    • It is not coding, legal, or financial advice and does not replace payer validation or a qualified coder.
    Related

    Seeing the same denials again and again?

    Our denial management team can help review causes, correct and resubmit claims, and track patterns. Please do not include patient information in the form.

    Get a Free Revenue Cycle Assessment

    Frequently asked questions

    01Is this a claim scrubber?

    No. It is an educational checklist you work through yourself. It does not read, check, or transmit claims, and it cannot validate a claim against a payer’s rules.

    02Will following this checklist guarantee a claim is accepted or paid?

    No. Payers apply their own rules, edits, and policies, and decisions can change. Use the checklist to catch common problems before submission, and confirm payer-specific requirements directly with the payer.

    03What is a clean claim?

    Generally, a claim that is complete and accurate enough to be processed without extra information or correction. Exact definitions and deadlines can vary by payer and contract.

    04Why does the checklist avoid listing filing deadlines or code rules?

    Those vary by payer, plan, state, and date of service. Giving fixed numbers here could be wrong for your claim, so the checklist reminds you to look them up in your own contracts and payer manuals.

    05Is my information saved?

    No. Checkbox states stay in your browser and are cleared when you leave or reload the page. Printing is the way to keep a copy. Never enter patient information or protected health information.