INTELLIGENT CLAIM SCRUBBING
Find preventable claim issues before the payer does.
Intelligent Claim Scrubbing combines deterministic validation, configurable rules, payer logic, coding edits, and AI-assisted review to identify missing, inconsistent, or high-risk claim information before submission.
POTENTIAL CHECKS
- Patient, subscriber, provider, facility, and payer data completeness.
- Eligibility and coverage information where available.
- Required identifiers, modifiers, diagnosis-to-procedure relationships, and claim formatting.
- National and local coding edits, including applicable NCCI, LCD, NCD, and payer-specific rules.
- Authorization and referral requirements when data is available.
- Place of service, provider specialty, date, frequency, and policy logic.
- Duplicate, inconsistent, or conflicting information.
- Organization-specific billing rules and high-risk patterns.
- Documentation or charge-capture dependencies where integrated.
OUTPUT
- Clear issue description
- Severity or submission risk
- Source rule or policy reference
- Recommended correction or review action
- Queue assignment
- Override & audit trail
- Trend reporting
Find potential issues before they become payer problems.
Talk with our team about your patient-access, revenue-cycle, digital-care, analytics, or integration priorities.