Elements of a Clean Claim

Claims that do not contain the required elements will be rejected and the provider will be required to resubmit after making the necessary corrections. Most  information needed to submit clean claims is available in the authorization detail on the ContinuUs Provider Portal. Rate information for negotiated rate services is available on the Services, Rates, and Special Provisions Letter (SRSP).

Elements of a clean claim are as follows:

  • Member name
  • Member number (Social Security Number)
  • Member date of birth
  • Provider tax I.D.
  • Provider NPI number (if applicable)
  • Provider name and address
  • Dates of service (If the claim is for multiple months of service, you must use a separate line for each month.)
  • Type of Bill code (if applicable) 
  • Modifier (if applicable)
  • Authorization number
  • Number of units of service provided (The number of days billed in the date span on a claim for daily unit services must match the number of day units billed.)
  • Total units cost

If the service provided is a Medicaid service, the clean claim must also be submitted in a format and coding system acceptable to Wisconsin’s Medicaid program.