New York Tries To Clarify Clean-Claim Definition

Since 1997, the New York Insurance Department has received more than 88,000 complaints from doctors, hospitals and other providers about slow health carrier payments, and many involved questions about whether claims were clean claims, according to state Insurance Superintendent Gregory Serio.

The New York department has organized a forum to give carriers and providers a chance to discuss clean-claim standards. But creating an emergency definition in Regulation 178 "will prevent providers from submitting unnecessary complaints to the Insurance Department regarding claims that are deficient," Serio writes in a document that explains the need for adopting Regulation 178 as an emergency measure.

But Regulation 178 leaves some room for interpretation, because it notes that providers can leave information out when fields are "not relevant in a particular instance."

The New York department has posted the emergency regulation on the Web at http://www.ins.state.ny.us/remgindx.htm