Claims Editing and Scrubbing

Clean claims are the cornerstone of a successful revenue cycle. The more errors that can be caught before submission, the fewer denials and delays your practice will face. That’s why claims editing and scrubbing is such a critical step in medical billing—it ensures each claim is reviewed for accuracy, compliance, and completeness before it ever reaches the payer.

What Is Claims Scrubbing?

Claims scrubbing refers to the automated process of checking a medical claim for coding accuracy, formatting errors, and payer-specific rules before submission. This process helps practices avoid common billing mistakes and dramatically improves first-pass acceptance rates.

In short, it’s your claim’s first line of defense—designed to catch errors before the payer ever sees them.

What Editing and Scrubbing Tools Check For

Effective scrubbing software evaluates each claim against thousands of validation rules. The goal is to detect issues that could result in denials, payment delays, or compliance risks. Here are some of the most common checks:

• Missing or incorrect CPT, ICD-10, or HCPCS codes
• Unbundling and upcoding risks
• Invalid or expired patient insurance data
• Modifiers not matching services rendered
• Place-of-service or provider ID mismatches
• Payer-specific formatting or policy errors

These systems are designed to mirror the checks performed by insurers, increasing the likelihood of a successful submission on the first attempt.

Why Pre-Submission Scrubbing Matters

Scrubbing claims before submission can save your practice significant time and money. It reduces the administrative burden of managing rejections and shortens the reimbursement timeline. More importantly, it prevents systemic issues from affecting long-term revenue performance.

Without scrubbing, even small errors—like a missing modifier or miskeyed patient ID—can turn into major delays in payment.

Common Issues Caught by Scrubbing

Practices that skip or underuse claim scrubbing often encounter high rejection rates. Here are some examples of what gets flagged most frequently:

• Billing for services that don’t match diagnosis codes
• Using outdated or deleted CPT or ICD-10 codes
• Filing claims outside of the payer’s filing window
• Incorrect NPI numbers or taxonomy mismatches
• Claims missing required authorizations or documentation

Our Approach to Claim Scrubbing

At Quest National Services, we combine intelligent technology with expert review to ensure every claim is clean and complete. Our claim editing software is constantly updated with new payer rules and medical coding changes. Each claim is reviewed by our billing professionals before submission to ensure accuracy and compliance.

We also provide analytics on rejection trends so your practice can proactively prevent future issues.

Conclusion: Fewer Errors, Faster Payments

The difference between a denied claim and a paid claim often comes down to a few missing details. Claims editing and scrubbing eliminate these issues before they interfere with your revenue. For practices that want to reduce rework, increase first-pass approval rates, and accelerate their revenue cycle, this step is essential.

Quest National Services takes the guesswork out of billing by ensuring your claims are correct before they go out the door.

For informational purposes only.