Objective :

After claims are finalized and submitted, any claims held due to scrubber edits or clearinghouse rejections are reviewed and resolved promptly to ensure timely submission to payers and prevent payment delays.

Key Responsibilities :

Claim Scrubbing Review

Purpose: Identify and correct issues flagged by internal or clearinghouse scrubbers before payer submission.

Validate and correct:

  • Missing or invalid CPT/ICD-10 codes
  • Incorrect modifiers
  • Invalid or incomplete patient demographics
  • Missing prior authorization or referral information
  • Reprocess and revalidate corrected claims through the scrubber.

Clearinghouse Rejection Management :

Purpose: Address claims rejected by the clearinghouse before reaching the payer.

Common Rejection Reasons :

  • Invalid payer ID or insurance info
  • Provider not credentialed with payer
  • Eligibility mismatches
  • Format or transmission errors

Responsibilities :

  • Monitor clearinghouse work queues or rejection reports daily.
  • Review each rejection’s error message/code to determine the cause.
  • Coordinate with billing, registration, or coding teams to correct data.
  • Refile corrected claims through the clearinghouse.

Tracking & Turnaround :

Purpose: Ensure all scrubbed or rejected claims are resolved within 24–48 hours to maintain clean claims rate and prompt reimbursement.

Responsibilities :

  • Maintain a daily log or dashboard of rejected/scrubbed claims.
  • Use claim control numbers (CCNs) to track the lifecycle of each resubmitted claim.
  • Prioritize rejections by payer turnaround time and filing deadlines.

Our Best Practices :

  • Automate scrubber alerts or route flagged claims to dedicated queues.
  • Use standardized denial/rejection reason codes to guide correction protocols.
  • Develop a knowledge base or quick reference guide for common rejections and fixes.
  • Hold weekly review meetings to analyze patterns and address root causes.

Why It’s Important :

Scrubbed and rejected claims represent preventable revenue delays. Rapid resolution reduces A/R days, supports a high clean claims rate, and improves overall payer relations.