Turn Claim Scrubbing Into a Revenue Cycle Advantage
A claim can appear complete while still containing errors that trigger rejection or denial. The module validates the relationships between codes, units, modifiers, diagnoses, and coverage rules.
Prevent Rejections With Pre-Submission Claim Intelligence
Identify coding and billing issues before the claim reaches the clearinghouse or payer. Our claim scrubbing software runs critical edits across the claim to help your team resolve NCCI conflicts, MUE violations, modifier issues, add-on code errors, and coverage-related discrepancies before submission.
Reduce Claim Rework and Submission Cycles
Stop sending claims back and forth between the biller, clearinghouse, and payer. Catch issues at the source and correct them before the initial submission, helping your team reduce avoidable claim rejections, resubmissions, and manual follow-up.
Give Billers Actionable Edits, Not Just Error Codes
Don’t make your billing team interpret cryptic edit codes or NCCI messages. Every finding explains the issue and points to the specific claim line or field that needs attention, so billers know exactly what to fix.
Validate Every Element of the Claim
Go beyond basic form-level validation. Scrub CPT/HCPCS codes, modifiers, units, diagnosis pointers, service lines, and claim-level relationships to identify issues that could affect clean-claim submission.
Fits Into Your Existing 837 Workflow
Keep your existing practice management system, billing platform, and clearinghouse. Import the 837 you already generate, scrub and correct the claim, regenerate the clean 837, and send it through your existing submission workflow
Accelerate Clean-Claim Submission Rates
Move from claim creation to validation to submission without unnecessary handoffs. Generate the corrected 837, submit through the clearinghouse, and maintain supporting documentation against the encounter.
Features Built for Smarter Claim Scrubbing Using AI
Turn remittance data into prioritized work, evidence-backed appeals, and measurable recovery.
Comprehensive Claim Validation
Validate the complete claim before submission. Check service lines, codes, modifiers, units, diagnosis pointers, and required fields to identify issues where they actually occur.
Code Validity Checks
Verify that codes exist, are billable, and were effective on the service date. Catch invalid coding before the claim leaves your system.
NCCI Unbundling Edits
Identify procedure pairs that cannot be billed together. Apply modifier-indicator handling to determine whether the combination can be appropriately billed.
MUE Unit Validation
Check submitted units against the published maximum for each code. Flag excessive units before they become a submission issue.
Add-On Code Validation
Check add-on procedures against their required primary procedures. Flag missing primary services before submission
Modifier Compatibility
Validate modifiers against individual codes and modifier combinations. Identify modifiers that are invalid or cannot be used together.
Actionable Error Guidance
Turn technical claim edits into clear next steps. Every finding identifies the affected line or field and explains what needs to be corrected
837 Claim Generation
Generate a clean 837 from the validated claim record. View and download the file before submission when needed.
Direct Claim Submission
Send validated claims through your clearinghouse instead of exporting files for manual movement between systems
Choose a Smarter Claim Scrubbing and Submission Workflow
A streamlined claim-scrubbing workflow takes the claim you already produce, validates it, guides corrections, and sends the clean claim to the payer.
1. Import the Claim
Start with the 837 claim file your existing billing or practice management system already generates.
- Import the complete claim
- Support professional, dental, and institutional claim types
- Preserve claim information throughout the validation process
2. Validate the Claim
Run the claim against applicable coding and payer-related edits before submission.
- Validate code validity
- Check NCCI procedure pairs
- Validate MUE unit limits
3. Identify and Explain Errors
Surface findings directly where the problem occurs instead of forcing billers to interpret a separate error list.
- Identify the affected claim field or line
- Explain what is wrong
- Provide the correction required
4. Correct and Re-Scrub
Make the required changes and validate the claim again before it leaves the organization.
- Correct identified claim issues
- Re-run applicable edits
- Confirm that preventable issues have been addressed
5. Generate a Clean 837
Create the outbound claim file from the same claim record.
- Make the file viewable and downloadable
- Identify any field that could not be serialized
- Maintain the same underlying record across claim formats
6. Submit to the Payer
Move the validated claim directly into submission rather than exporting it for another manual step.
- Submit through the clearinghouse
- Generate CMS-1500, ADA, or UB-04 forms when needed
- Retain supporting attachments against the encounter
Beyond Off-the-Shelf Claim Scrubbing Software
See how our AI-based claim scrubbing software goes beyond basic rule checking
Recommended Readings
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Frequently Asked Questions
- What is AI-based claim scrubbing software?
- What types of claim errors can the software identify?
- Can the claim scrubbing software work with our existing billing system?
- What claim formats does the software support?
- 5. How does the software help billers correct claim errors?
- Can scrubbed claims be submitted directly to the clearinghouse?
