Claim Scrubber
Check claims for coding errors, missing information, and compliance issues before submission.
Documentation draft — not a verified product specification. The exact edit catalogue and coverage require verification. This page does not assert a specific field list as mandatory.
Overview
Claim Scrubber helps users review non-identifying, structured claim information for potential coding, modifier, place-of-service and other configured inconsistencies before further professional review. It is a decision-support check, not a claim submission engine or guarantee of payment.
A common problem it addresses: conflicts may be overlooked when staff manually compare codes, modifiers, POS and payer guidance across multiple sources.
Who should use it
Medical billers, coders, billing supervisors and practice staff.
Prerequisites
A synthetic, structured claim scenario. Never add patient name, DOB, member ID, address or clinical chart text. See Data and Privacy.
Inputs
Possible structured fields include:
- Diagnosis code(s).
- Procedure or service code(s).
- Modifier(s).
- Place of service.
- Payer name/type.
- State or jurisdiction.
- Other non-PHI fields explicitly provided by the current application.
Verify actual fields and which are mandatory. Do not treat this list as the deployed field list.
Step-by-step instructions
- Open Claim Scrubber.
- Review field instructions and data restrictions.
- Enter a synthetic, structured claim scenario.
- Run the configured checks.
- Review any errors, warnings or informational flags.
- Open the rationale/source information if the UI provides it.
- Correct the scenario or confirm the rule with official payer and coding references.
- Re-run the review if supported.
Example workflow (synthetic / non-PHI only)
A biller enters a synthetic procedure code, modifier, POS and diagnosis code. The tool highlights a potential inconsistency. The biller verifies the official guidance and adjusts the data in the originating billing system as appropriate. No real claim or patient record is transmitted through Assurlytics.
Understanding results
Distinguish:
- Error: a configured rule flags a significant issue; exact severity semantics must be confirmed.
- Warning: potential conflict requiring human review.
- Informational finding: context, recommendation or documentation check.
- No flags: no issue detected by the configured checks; not a guarantee that a claim is correct or payable.
Document actual severity names and validation logic from the application. AI explanations should describe a finding; they must not invent payer-specific requirements.
A clean result only indicates that the configured checks did not flag an issue in the supplied scenario. It does not guarantee payment.
Limitations
- Rule coverage may vary by code system, payer, state and effective date.
- Not every payer-specific edit is necessarily included.
- No guarantee of denial prevention or claim acceptance.
- Not a replacement for a certified coding edit engine or clearinghouse unless explicitly implemented and contracted.
Troubleshooting
Check required fields, code formatting, selected payer, unsupported combinations, expired code versions and service availability. Capture actual error text and recovery steps from the deployed UI.
- A flag you do not understand: read the flag text in full and check the related Code Lookup result or payer guidance before changing a code.
- Missing information flags: complete the missing field in your source system, not only in the scrubber view, where your process requires it.