Presubmission Claim Scrub, Making Sure Your Claims are Clean
Among the dozens of scrubs we offer are:
- Government Correct Coding Iniative (CCI) edits, which watch for mutually exclusive
procedure codes and for use of a comprehensive code with a component
- Government Local Coverage Determination (LCD) policies, which watch for incompatible
- Duplicate services on same day even if not on the same claim, if without proper modifiers.
- Missing service facility for lab services.
- Missing accident date if diagnosis indicates an accident.
- Missing hospital discharge date if the payer requires it.
- Missing referring provider if the speciality or code requires it.
- Missing date last seen by physician for such practices types as physical therapy.
- Many more ...
Scrubs can be customized to catch particular situations faced by particular practices
or specialties. A user can run the scrub process against only claims she has entered,
or against all pending claims for all users. Claims failing the scrub appear on
the application tree, with or without having been formally placed on hold, depending
on the preference of the user. Immediately prior to generating electronic claims
at the end of the day--a centralized process that we perform--we run the scrub again,
and place failed claims on hold, which puts them on a list for the practice to fix.
The list includes a reference to the claim and a description of the error.
Whether for us or for users, scrubbing is a batch process, improving performance
when saving individual claims.