Claim scrubber

The scrubber checks a draft claim against the data a payer needs before you send or print it. A claim must pass the scrubber to become Scrubbed, and only a scrubbed claim can be printed. Submit scrubs each claim on the way, so a draft that passes is sent (see Submit claims).

Scrub a claim#

Open the claim from Billing, then Claims, and choose Scrub Claim. The Scrubber tab lists what it found. When nothing blocks the claim, it moves to Scrubbed.

Changing a scrubbed claim (its Box 19 text, notes or lines) sends it back to Draft, so scrub it again before sending.

What the findings mean#

Each finding has a severity:

The Box column names the CMS-1500 box (and the line, when it is one line's). Fix in links to the place to correct it: the practice, a location, a provider, a payer, a physician, a charge, or the patient's coverage, consents, authorizations or plans of care.

What the scrubber checks#

• Billing provider: name, a valid NPI, a nine-digit tax id (EIN), a taxonomy code, and a full address with a nine-digit ZIP code. These come from the practice, or from the location when it bills under its own identity.
• Rendering provider: a valid NPI and a license for the service state that covers the dates of service. When the payer requires enrollment and the provider is not enrolled, it is an overridable block.
• State-required credentials: a warning when the service state requires a credential the rendering provider does not hold there on the date of service, such as a technician registration (state-required credentials). It never blocks the claim.
• Supervised services: a visit still waiting for its supervisor's co-signature blocks, and so does a provider whose credential the payer does not pay for, or pays only with the supervisor as the rendering provider.
• Subscriber: the member id, the subscriber's name and birth date, and the relationship to the patient.
• Release of information and assignment of benefits (Boxes 12 and 13) on file for the date of service, for electronic claims.
• Authorization: when the payer requires one, an approved authorization covering every date of service. This is an overridable block.
• Diagnoses: at least one, each billable on the dates of service, and one to four pointers on every line.
• Codes and modifiers: each code active for the discipline on its date and each modifier valid. Units above the code's medically unlikely edit (MUE) are an overridable block, for when the documentation supports them.
• Code pairs: a pair of codes that pays only with a distinct-service modifier is a warning suggesting 59 or an X modifier.
• KX modifier: a line past the Medicare therapy threshold needs the medical necessity attestation on the plan of care.
• Timely filing: a warning within 15 days of the payer's filing limit. Past the limit, the claim needs a delay reason code and an override.
• Duplicates: the same code and date already billed to the payer on another claim that was not voided.
• Code booking limits: a timed line with fewer or more minutes than the code (or the payer's code rule) allows, or a code allowed once a day billed twice that date for the patient (or by the same provider). This is an overridable block (see booking limits).
• Payer: an electronic claim needs the payer's clearinghouse payer id; a paper claim warns when the payer has no claims mailing address.
• Ordering provider: Medicaid claims need the ordering provider on the episode, and any referring or ordering provider needs a valid NPI.
• Plan of care certification: when the payer requires it, a signed or verbal certification. This is an overridable block.

Override a block#

On the Scrubber tab, choose Override on an overridable block, give the reason and choose Override and Scrub. The claim is scrubbed again with the override. Overrides stay on the claim with who made them, when and why; they are listed under Overrides.