Claims checked before they leave, not after they bounce
Each claim is scrubbed against payer-specific rules, NCCI procedure-to-procedure edits, medically unlikely edits and eligibility before it is submitted electronically.
What’s included
- Clearinghouse and payer-specific edits
- NCCI PTP and MUE checks
- Modifier validation (25, 59, XE/XS/XP/XU, 95, GT and others)
- Place of service and taxonomy checks
- Electronic submission of 837P and 837I claims
- Rejection worklist cleared daily
How we handle it
Scrub
Claims run through edits for coding, payer and demographic errors.
Correct
Errors are fixed before submission, not after.
Submit
Claims go out electronically, with paper only when a payer requires it.
Confirm
999 and 277CA acknowledgments are checked so no claim is lost.
Details that matter
A rejection means the claim never reached the payer’s adjudication system, so the timely filing clock keeps running. A denial means it was processed and refused. Many practices track denials but never see rejections. We check acknowledgment files (999 and 277CA) daily so rejected claims are fixed and resubmitted right away.
Questions about claim scrubbing and submission
What is the difference between a rejection and a denial?
A rejection is stopped before processing, usually for data errors. A denial means the payer processed the claim and refused to pay it. Rejections must be fixed and resubmitted quickly because filing limits keep running.
Can you submit paper claims?
Yes, on CMS-1500 or UB-04 when a payer requires it, but electronic submission is faster and easier to track.
See where your revenue is going.
Send a few details and we will set up a short call to review your claims, denials and A/R. No cost and no commitment.
We sign a Business Associate Agreement before we handle any patient data.