The system can be configured to automatically accept clean claims based on information received in a claim reconciliation file.

The system can be configured to automatically accept clean claims based on information received in a claim reconciliation file.

• A. True
• B. False
• C. Only during business hours
• D. Not configurable

Answer: (A)

Automatic acceptance of clean claims using data from the claim reconciliation file is a configurable automation capability. When the reconciliation file presents the expected values for key claim elements—such as patient details, dates of service, CPT/HCPCS codes, modifiers, charges, and payer-specific edits—the system can flag the claim as clean and move it forward to payment without manual review. This speeds processing and reduces labor, but it relies on well-defined validation rules so that only truly complete and accurate data trigger auto-acceptance. Because this relies on configured criteria, it typically operates continuously as reconciliation data is received, not restricted to a specific time like business hours. You can adjust what constitutes a clean match, set thresholds, and define how exceptions are handled to prevent incorrect auto-acceptance.

Automatic acceptance of clean claims using data from the claim reconciliation file is a configurable automation capability. When the reconciliation file presents the expected values for key claim elements—such as patient details, dates of service, CPT/HCPCS codes, modifiers, charges, and payer-specific edits—the system can flag the claim as clean and move it forward to payment without manual review. This speeds processing and reduces labor, but it relies on well-defined validation rules so that only truly complete and accurate data trigger auto-acceptance. Because this relies on configured criteria, it typically operates continuously as reconciliation data is received, not restricted to a specific time like business hours. You can adjust what constitutes a clean match, set thresholds, and define how exceptions are handled to prevent incorrect auto-acceptance.