What are the definitions of "payment floor" and "clean" claim?
The “payment floor” is a waiting period during which time the contractor may not pay, issue, mail, or otherwise finalize the initial determination on a clean claim. There are different waiting periods for electronic claims and paper claims. The waiting periods are 13 days for electronic claims and 28 days for paper claims. However, the payment may not be issued until day 14 (electronic) or 29 (paper).
A “clean” claim is one that does not require the carrier or fiscal intermediary to investigate or develop external to their Medicare operation on a prepayment basis. Clean claims must be filed in the timely filing period.
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