If a Medicare claim is submitted electronically and there are no errors, what is the classification?

• A. Clean claim
• B. Denied claim
• C. Fraudulent claim
• D. Duplicate claim

Answer: (A)

When a Medicare claim is submitted electronically and there are no errors, it is considered a clean claim. This means all required data are present, codes are correct and complete, patient and provider information are accurate, and the claim passes the payer’s automated edits. A clean claim can move straight to processing and payment without needing additional information or corrections, which speeds adjudication.

If there were issues, the claim would typically be denied or suspended for corrections, or flagged as fraudulent or a duplicate, but with no errors present those scenarios don’t apply. A denied claim results from missing or incorrect data that fails edits, while a duplicate claim occurs when the same service is submitted more than once; fraudulent claims involve intentional misrepresentation.