Manage Claim Scrubbing

Claim Scrubbing helps you manage the complex rules and terminology of coding. This feature is used to analyze the claims before submission to the clearinghouse as a solution for catching problem claims, maximizing the potential for your healthcare facility to be paid correctly on the first submission. 

Types of Claim Scrubbing Edits

  • NCCI Edits: Prevents improper payments of procedures that should not be billed together.
  • CPT/HCPCS Edits: Code Validation, Age Validation, Gender Validation, Add-On Code Edit, Relative Value Units sequencing.
  • ICD Code Validation: Date of Service, Specificity, Valid Primary Diagnosis, Duplicate Diagnosis.
  • Modifier Use: Date of Service, Global Fee Period, Invalid Modifier Use.
  • Medical Necessity: Proprietary Medical Necessity, Non-Primary Diagnosis should be primary.

If you're the Auth Rep, follow the steps below to enable, configure, or disable claim scrubbing:

  1. Select Account Administration > Services.

  2. Click the button next to Claim Scrubbing. 

  3. The Enable Claim Scrubbing box allows you to enable or disable this service.

  4. Set your Claim Scrubbing Settings:

    1. Automatically scrub new claims as they are entered?: Select Yes to have the system automatically scrub all new claims after they are entered.

    2. Automatically scrub existing claims when changes are made?: Select Yes to have the system automatically scrub claims after a coding change has been applied.

    3. Only perform automatic claim scrubbing for claims that contain more than one charge?: Select Yes to have the system automatically scrub claims only if they contain two lines or more.

    4. Exclude procedure codes marked as Retail or Other Medical from the code scrubbing process?: Select Yes so procedure codes with the specified types are not included in the Claim Scrubbing process, resulting in misleading errors. 

  5. Optional: Select Copy Configuration to copy these settings to another customer account you manage.

    1. Check the box next to the customer account(s) to copy the settings to, then click Copy.

  6. Click Save