Clinical Claims Scrubbing
Practice Insight offers optional clinical claims scrubbing as a part of the EDIinsight solution. The clinical claim scrubber verifies the technical and coding accuracy before your claims are filed by identifying potential problems that will cause claim rejection or reduction in payment.

The clinical claim scrubber provides a comprehensive set of coding and technical edits. Each individual edit may be enabled or disabled completely, for a specific claim type or for an individual payer. Some of these edits include:

• LMRP medical necessity
• Proprietary medical necessity
• RVU sequencing
• CCI/CCP
• E/M over/under coding
• Correct modifier usage
• ICD-9 validity, ultimate specificity, secondary code suitability and V-code validity
• CPT/HCPCS/ICD-9 current year validity
• CPT/patient gender suitability
• CPT/patient age compatibility
• Assistant surgeon rules
• Add-on/parent code resolution
• Medicare non-covered services
• Statutorily excluded services