Which statement best describes the information typically required on a medical claim to ensure clean submission?

• A. Patient demographics and date(s) of service only.
• B. CPT/HCPCS codes and ICD-10-CM codes only.
• C. Patient demographics, date(s) of service, CPT/HCPCS procedure codes, ICD-10-CM diagnosis codes, provider NPI, place of service, charges, and payer information.
• D. Payer information only.

Answer: (C)

Submitting a clean claim relies on having all the essential data so the payer can adjudicate it correctly on the first pass. The most complete set includes patient demographics, date(s) of service, CPT/HCPCS procedure codes, ICD-10-CM diagnosis codes, the provider’s NPI, place of service, charges, and payer information. Each piece serves a clear purpose: demographics confirm who the patient is and support eligibility; dates of service anchor the claim to the correct visit or procedure; CPT/HCPCS codes describe the procedures performed; ICD-10-CM codes justify medical necessity and link to the CPT codes; the NPI identifies who provided the service; place of service indicates where the service occurred and affects reimbursement rules; charges state the billed amount; payer information directs submission to the correct payer/plan. Leaving out any of these fields can lead to delays, requests for resubmission, or outright denial, so including all of them helps ensure smooth processing.