Claim Scrubbing
Six stages. Zero missed errors.
Every claim passes through our multi-stage validation pipeline before submission. Catch problems at the source, not in a denial letter.
1 Eligibility Verification
2 Modifier Validation
3 Diagnosis Validity
4 Hold Rules
5 Claim Implosion
6 Output & Submission
The Pipeline
1 Eligibility Verification
Real-time payer checks before submission. Catches expired coverage, inactive policies.
Eligibility Verification
Real-time payer checks before submission. Catches expired coverage, inactive policies.
- Real-time eligibility queries to payer databases
- Catches expired coverage and inactive policies before submission
- Validates subscriber ID and group number accuracy
- Detects coordination of benefits issues early
- Reduces eligibility-related denials by up to 85%
2 Modifier Validation
Cross-references CPT codes with modifiers. Catches 26/TC conflicts, gender-specific errors.
Modifier Validation
Cross-references CPT codes with modifiers. Catches 26/TC conflicts, gender-specific errors.
- Cross-references CPT codes with applicable modifiers
- Catches 26/TC (professional/technical) component conflicts
- Validates gender-specific procedure and modifier combinations
- Ensures modifier ordering follows payer-specific rules
- Flags missing required modifiers for common lab procedures
3 Diagnosis Validity
ICD-10 code validation. Age/gender appropriateness, specificity requirements.
Diagnosis Validity
ICD-10 code validation. Age/gender appropriateness, specificity requirements.
- Validates ICD-10 code format and active status
- Checks age and gender appropriateness for each diagnosis
- Ensures codes meet specificity requirements (no truncated codes)
- Validates diagnosis-to-procedure medical necessity linkage
- Catches outdated or retired diagnosis codes
4 Hold Rules
Configurable business rules. Payer-specific requirements, bundling logic, frequency limits.
Hold Rules
Configurable business rules. Payer-specific requirements, bundling logic, frequency limits.
- Configurable per-client and per-payer business rules
- Enforces payer-specific billing requirements automatically
- Frequency limit checks prevent duplicate billing
- Bundling logic detects improperly unbundled services
- Custom hold rules for lab-specific compliance requirements
5 Claim Implosion
Combines related line items. Reduces claim count, maximizes reimbursement.
Claim Implosion
Combines related line items. Reduces claim count, maximizes reimbursement.
- Combines related line items into optimized claims
- Reduces overall claim count submitted to payers
- Groups services by date, provider, and payer intelligently
- Maximizes reimbursement through strategic line item grouping
- Prevents claim splitting that triggers audits
6 Output & Submission
Clean claims ready for clearinghouse. Real-time submission status tracking.
Output & Submission
Clean claims ready for clearinghouse. Real-time submission status tracking.
- Generates clean 837P/837I electronic claims
- Direct submission to STEDI clearinghouse
- Real-time submission status tracking and acknowledgments
- Automatic error notification and resubmission workflows
- Complete audit trail for every claim touchpoint
98.2%
First-pass acceptance rate
674K+
Claims scrubbed
6 stages
Validation checkpoints
Stop losing revenue to preventable denials
See how the scrubbing pipeline catches errors before they cost you money.