What term is used for claims that are accepted for adjudication by payers?

The term used for claims that are accepted for adjudication by payers is "clean claims." A clean claim is one that has been submitted with all the required information and meets the payer's criteria for processing without any errors or missing details. This means that it is free of defects that could lead to delays in payment or denial.

When a claim is categorized as clean, it signifies that the payer can begin the evaluation process to determine reimbursement. This effectively streamlines the billing process and helps ensure that healthcare providers receive timely payments for services rendered. In contrast, rejected claims may have errors that prevent them from being processed, denied claims have been evaluated and determined not payable, and pending claims are still under review or awaiting further information. Therefore, clean claims are integral to the efficiency of the medical billing cycle.