Cleaner Claims Before They Reach the Payer
Pre-submission validation, demographic checks, eligibility-related errors, coding edits, and payer rule checks — so claims leave your system cleaner the first time.
Illustrative workflow — steps adapt to your practice
What this service includes
Claims management focuses on the window between charge entry and submission, where most avoidable rejections originate. Automated scrubbing validates demographics, eligibility-related data, coding edits, and payer-specific formatting rules before claims are submitted. Specialists review flagged exceptions so corrections happen upstream rather than after a payer rejection.
- Where it fits in the revenue cycle
- How it supports practice operations
- How human specialists remain accountable
How this service works
AI-assisted. Expert reviewed.- 01
Data Validation
Verify demographics, subscriber data, and required fields are present and correct.
Who: AutomationValue: Missing data caught before submission. - 02
Coding Edit Review
Check CCI edits, bundling, and modifier logic before submission.
Who: Automation, reviewed on exceptionsValue: Coding edits resolved without a payer rejection. - 03
Payer Rule Checks
Validate claims against payer-specific formatting and requirement rules.
Who: Automation, reviewed on exceptionsValue: Claims match payer expectations on first send. - 04
Exception Review
Specialists review and correct claims flagged by scrubbing rules.
Who: Claims specialistsValue: Flagged claims corrected by people, not auto-rejected. - 05
Electronic Submission
Submit clean claims through the appropriate clearinghouse and payer channels.
Who: AutomationValue: Claims delivered on time and in the right format.
Core capabilities
The specific functions included in this service, each handled by experienced specialists with automation support.
Claim Scrubbing
Automated pre-submission checks across demographics, coding, and formatting.
Data Validation
Required fields, subscriber data, and demographic accuracy verified.
Coding Edit Review
CCI edits, bundling, and modifier logic checked before submission.
Payer Rule Checks
Payer-specific formatting and requirement rules validated per claim.
Electronic Submission
Clean claims submitted through clearinghouse and payer channels.
Rejection Tracking
Rejections logged, categorized, and routed for correction.
Resubmission Support
Corrected claims resubmitted promptly after rejection resolution.
Common operational challenges we address
The real issues this service is designed to resolve — without exaggerated outcomes or guaranteed results.
Avoidable rejections
Demographic errors, missing data, and coding edits cause rejections that scrubbing could have caught.
Payer-specific formatting
Each payer has distinct requirements; generic submission misses these rules.
Rejection loops
Rejected claims are corrected and resubmitted without fixing the underlying scrubbing gap.
Submission delays
Manual submission workflows delay claims reaching payers within filing windows.
Technology where it helps. Expertise where it matters.
Automation handles volume and consistency. Experienced specialists handle judgment, review, and accountability.
How technology supports this service
- Scrubbing rules validate demographics, coding edits, and payer formatting automatically
- Exception queues route flagged claims to specialists by issue type
- Submission tracking confirms claims were received and accepted by payers
- Rejection analytics surface recurring issues for process improvement
How specialists provide oversight
- Specialists review every flagged exception before correction
- Payer-specific rule interpretation requires human judgment
- Complex claims with multiple edits are reviewed by experienced specialists
- Rejection trends are analyzed and fed back into scrubbing rules
Reporting and visibility
The categories your team will see in reporting for this service.
Claims scrubbed
1,180
+3.4% MoM
First-pass acceptance
92%
+2.1% MoM
Edit flags resolved
47
-9 MoM
Avg. scrub time
1.2s
-0.3s
Illustrative dashboard data — not actual client results
How we get started
A structured four-step process from initial assessment to ongoing management.
Assessment
Submission workflow assessment
Scope
Payer and clearinghouse review
Onboarding
Scrubbing rule configuration
Ongoing
Ongoing submission with rejection reporting
Solutions adapted to your specialty
Every specialty has its own coding rules, payer quirks, and revenue patterns. Our teams know the difference.
Questions about this service
If something is not covered here, our team is happy to walk through it during your assessment.
Scrubbing validates demographics, required fields, coding edits, bundling rules, and payer-specific formatting before claims are submitted.
Catch Claim Errors Before They Become Rejections
Start with a focused review of your claim submission workflow and see where pre-submission validation can reduce rejections.