State RegulationsNJ specificDifficulty 1/5
For purposes of New Jersey's prompt-pay deadlines, what makes a health claim a 'clean claim'?
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Answer & full 3-part explanation (select an option above, or peek)
Why B is correct
Under New Jersey's prompt-pay framework — N.J.S.A. 26:2J-8.1d together with N.J.A.C. 11:22-1.6 — a clean claim is one that contains all required information and lacks any defect or imprecision, so that the carrier can process it without needing additional material information. The fixed 30-day and 40-day payment windows key to clean claims, which is why completeness at submission is what starts the clock. The New Jersey Department of Banking and Insurance enforces the deadline structure.
Why the other options are wrong
- A) Physician pre-approval is not the test; cleanliness turns on the completeness of the claim data the carrier receives.
- C) A carrier's decision to pay in full without review is not what defines cleanliness; the definition concerns the claim's content.
- D) A duplicate claim is defective processing material, not a clean claim that triggers the payment window.
Memory hook
Clean = complete: nothing missing, nothing unclear — that starts the clock.