A claim submitted without all required fields is described as which type?

• A. Incomplete claim
• B. Clean claim
• C. Denied claim
• D. Bundled claim

Answer: (A)

When a claim is submitted without all required fields, it isn’t ready for processing because the payer needs complete information to determine coverage and payment. Essential data include patient and provider identifiers, dates of service, diagnosis codes, procedure codes, modifiers if needed, and payer details. Without these, the claim can’t be matched to the patient or service and is returned as incomplete. This is why the term used is an incomplete claim.

A clean claim, by contrast, has all necessary fields and passes initial edits so it can move forward in adjudication. A denied claim has been processed and then rejected for a specific reason after review. A bundled claim involves grouping multiple services for a single payment.