Claim Scrubbing
Service Overview
Our Claim Scrubbing service provides a rigorous automated and manual validation pipeline designed to catch coding and billing errors before claims leave your practice. This service includes CCI edit checks, ICD-10 and CPT cross-referencing, modifier verification, demographic validation, and payer-specific rule checks. With deep rules engine filtering and expert oversight, we ensure your claims achieve maximum first-pass rates and bypass costly payer rejections.
What’s Included
- NCCI Edit Auditing
Automatic checking against National Correct Coding Initiative guidelines to prevent unbundling and mutually exclusive coding.
- CD-10 & CPT Alignment
Cross-referencing diagnosis codes with procedure codes to ensure full medical necessity alignment.
- Modifier Accuracy Checks
Validation of proper modifier usage to prevent claim flagging, partial payments, or instant rejections.
- Demographic Verification
Scrubbing patient ID, group numbers, date of birth, and provider credentials to eliminate clerical errors.
- Payer-Specific Custom Rules
Tailored rule sets adapted to individual commercial and government payer billing quirks and requirements.
- Timely Filing Monitoring
Automated alerts tracking claim generation dates against specific payer timely filing limits.
- Duplicate Claim Screening
Identifying and stopping potential duplicate service submissions prior to transmission.
- Real-Time Error Reporting
Instant feedback reports highlighting flagged claims so corrections can be made immediately.
Ideal For
Medical practices seeking to drastically raise their clean claim rate, eliminate front-end clearinghouse rejections, and protect practice efficiency through flawless pre-submission auditing.
- Practices experiencing high rejection rates due to simple coding or demographic mistakes
- Clinics looking to minimize manual billing rework and administrative overhead
- Specialty groups navigating complex coding rules and frequent modifier usage
- Practices targeting a 98%+ first-pass clean claim acceptance rate
Why It Matters
Catching errors before submission is far cheaper and faster than appealing denied claims later. By scrubbing every claim against up-to-date industry and payer rules, our team protects your practice from preventable delays, ensuring faster payouts and a predictable revenue stream.