Sec. 0.5. (a) Except as provided in section 0.6 of this chapter, as used in this chapter, "clean claim" means a claim submitted by a provider for payment under the Medicaid program that can be processed without obtaining additional information from: (1) the provider of the service; or (2) a third party. (b) The definition under subsection (a): (1) includes a claim with errors originating in the state's claims processing system; and (2) does not include a claim: (A) from a provider who is under investigation for fraud or abuse (as used in 42 CFR 447.45(b); or (B) under review for medical necessity.
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