Why this step decides whether the claim gets paid
A claim can be technically complete and still fail. Payers apply their own front-end edits beyond the baseline HIPAA transaction requirements, and a claim that ignores a payer-specific rule is rejected before it is ever adjudicated. Each rejection cycle adds days to payment and consumes staff time that scrubbing would have avoided entirely.
Claims Submission and Scrubbing capabilities
Pre-submission validation
Every claim checked against payer-specific edits, National Correct Coding Initiative procedure-to-procedure edits, and medically unlikely edit unit limits before it is transmitted.
Demographic and eligibility cross-check
Patient and subscriber information validated against the most recent eligibility response so a claim is not rejected for a mismatch that was already known.
Electronic submission via 837P
Professional claims transmitted through your clearinghouse in the standard HIPAA X12 837P format.
Rejection report review
Clearinghouse and payer rejection reports reviewed and worked daily rather than accumulating in a queue.
Modifier and place-of-service validation
Modifiers and place-of-service codes checked against the circumstances of the service before submission, not assumed from a template.
Batch and real-time submission support
Claims submitted in the cadence your clearinghouse and payer mix support, whether batch or real-time.
Our claims submission and scrubbing process
Receive coded claims
Claims arrive from charge entry or coding with all required fields populated.
Run payer-specific edits
Each claim is checked against the specific payer's known edit set, not a generic template.
Run NCCI and MUE checks
Procedure-to-procedure and unit-limit edits are applied before submission.
Correct flagged claims
Claims that fail an edit are corrected or held for missing documentation, not submitted anyway.
Submit electronically
Clean claims are transmitted via the 837P transaction through your clearinghouse.
Work rejections same-day
Any rejection reports are reviewed and corrected the day they are received.
Claims Submission and Scrubbing questions answered
Claim scrubbing is validating a claim against known payer and coding edits before it is submitted. It catches issues such as invalid code combinations, missing modifiers, incorrect place-of-service values, and demographic mismatches, so the claim has already cleared the checks a payer would apply before it ever reaches them.
A clearinghouse rejection happens before the claim reaches the payer, usually because of a formatting or data error caught by the clearinghouse's own edits. A payer denial happens after the payer has received and adjudicated the claim. Scrubbing is aimed specifically at preventing the first category, since those errors are avoidable and cost nothing to catch in advance.
Coded claims are scrubbed and submitted on the same day they are received, so the limiting factor is usually how quickly documentation and coding are completed upstream, not the submission step itself.
X12 837P is the HIPAA-standard electronic format for submitting professional healthcare claims. It replaces paper claim submission for the large majority of payers and is transmitted through a clearinghouse rather than directly to each payer.
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