Long Term Care Certification Practice Test

What does a long-term care policy typically define as a 'clean claim'?

1. A claim with complete and accurate information

2. A claim submitted online

3. A claim with a lower deductible

4. A claim within the waiting period

The correct answer is: A claim with complete and accurate information

A long-term care policy defines a 'clean claim' as one that contains complete and accurate information. This means that the claim submission has all necessary documentation and information required by the insurer to process the claim without needing further information or corrections. When claims are submitted with errors or missing information, they can be delayed or denied, leading to complications for both the provider and the patient receiving care. A clean claim helps streamline the reimbursement process, ensuring that care providers are paid promptly for their services, which is crucial in the long-term care environment where timely cash flow can significantly impact operational effectiveness. In contrast to this, while submitting a claim online may be a component of the claims process, it does not inherently relate to the completeness or accuracy of the claims information. Similarly, having lower deductibles or submitting claims within a waiting period have no bearing on whether a claim is considered ‘clean.’ The focus is solely on the integrity and thoroughness of the claim's documentation.