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Chapter 1 - General Information Chapter 1 - General Information 2025

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The document outlines the scope and objectives of the Michigan Department of Transportation's (MDOT) Materials Quality Assurance (QA) Program. It details procedures for sampling, testing, and certifying materials used in construction projects to ensure compliance with federal regulations and specifications. The program includes independent assurance testing, personnel qualifications, project record retention, and guidelines for using commercial testing agencies. Additionally, it emphasizes the importance of visual inspections and proper documentation for quality control throughout the construction process.

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What is the difference between clean and unclean claims?

Clean Claims are claims that have all information in them and nothing is missing. If any mandatory or conditional information is missing, the claim will be considered unclean. Examples of unclean claims include invalid member ID, provider data discrepancy NPI and atax ID does not match.

Which is considered a clean claim?

Clean claim defined: A clean claim has no defect, impropriety or special circumstance, including incomplete documentation that delays timely payment.

What is the difference between clean claims and dirty claims?

Clean claims not only have no incomplete or inaccurate documentation that delays timely payments, but also for legal reasons. In the same vein, you may hear inaccurate or incomplete claims referred to as dirty claims.

What does entitlement to Medicare mean?

Individuals become entitled to Medicare on the effective date of enrollment in either Medicare Part A or B, whichever occurs earlier. For most individuals, this is when age 65 is attained.

What are the steps in the Medicare claims process?

Medicare claim process You present your Medicare ID card to your health care provider. Your provider sends your claim to Medicare. Medicare pays first and sends payment directly to the provider. Medicare sends you a statement saying what you owe. You pay the balance to the provider directly.

How long can an individual stay in an inpatient facility through Medicare before having to be recertified?

The first recertification is required as of the 12th day of hospitalization. Subsequent recertifications will be required at intervals established by the hospitals utilization review committee (on a case-by-case basis), but no less frequently than every 30 days.

What is a clean claim CMS?

A clean claim is one that does not require the Medicare Administrative Contractor (MAC) to investigate or develop external to their Medicare operation on a prepayment basis.

How does CMS define a clean claim?

Clean claim means a claim that does not contain a defect requiring the Medicare contractor to investigate or develop prior to adjudication. Clean claims must be filed within the timely filing period (see the Social Security Act 1842(c)(2)(B); ).

Chapter 1 - General Information Chapter 1 - General Information 2025

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