Glossary, billing and revenue
What is claims scrubbing?
Claims scrubbing is the check an insurance claim goes through before it is submitted, to catch missing details, wrong codes and mismatches that would get it rejected. A clean claim is paid on first submission instead of coming back for correction.
Updated . Defined by the wai team for clinics, groups and health systems.
Also called claim scrubbing, claim edits or pre-submission claim check.
Why Claims scrubbing matters to a clinic
Every rejected claim costs twice, once in the delay to the money and again in the staff time to correct and resend it. For a clinic billing several insurers, a few percent of claims coming back is weeks of cash held up every month.
Most errors are simple. A code that does not match the note, a missing detail, the wrong format for that insurer. The earlier they are caught, ideally when the note is signed, the less they cost.
Questions
What does a claim scrubber check?
Typically that the patient and policy details are complete, that the codes are valid and consistent with each other, and that the claim is in the format the insurer accepts.
Is claims scrubbing done by people or software?
Both. Software catches the rule-based errors at volume, and a billing specialist resolves what it flags. See billing.
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