Get a Clean Bill of Health for Your Claims Before Their Submission.

EDIinsight® Clinical Claim Scrubber, powered by Alpha II, performs standard structural validation and advanced clinical claim scrubbing to drastically improve first-time acceptance rates.

Cleaning up your clinical coding on the front-end can have a significant impact on the reimbursement you get back from payers and how quickly it’s made available to your practice.

According to Respected Industry Organizations:

  • The average cost per claim to submit denials is $25 – AMA
  • 14% of claims are denied nationwide – HBMA
  • Inefficient health care claims processing, payment and reconciliation costs an estimated $21 to $210 billion; in the physician practice, this expense comprises 10 to 14% of practice revenue – AMA
  • For fiscal year (FY) 2015, the Medicare FFS program improper payment rate was 12.1%, representing $43.3 billion in improper payments – CMS

EDIinsight® Clinical Claim Scrubber, powered by Alpha II, can help reduce denials and ensure your practice sees optimal and timely reimbursement for care rendered. Delivering an easy-to-read, readily actionable response report detailing error causes, EDIinsight Clinical Claim Scrubber provides all of the information needed to correct claims in an html format, including a link to policy information. Further expediting resubmission, just the part of the report that is pertinent to each claim is attached to that claim for ease of use.

A Sampling of EDIinsight Clinical Claim Scrubber Edits

EDIinsight Clinical Claim Scrubber, powered by Alpha II,  allows for the verification of the accuracy of both professional and institutional claims and/or professional encounters against thousands of coding and billing requirements with real‐time turnaround. Claim accuracy is verified using the industry’s most comprehensive clinical scrubbing database built with years of continued development. Below is a mere sampling of the numerous data elements that drive the thousands of edits contained in Alpha II’s EDIinsight Clinical Claim Scrubber.


Greater Functionality Through Integration with EDIinsight® Suite of Products

When paired with EDIinsight® Claim Manager, EDIinsight Clinical Claim Scrubber can reduce A/R days since it supports ICD-10 procedure and diagnosis codes. Clinical Claim Scrubber also checks CPT®/ICD-10 combos for medical necessity. Response reports may be output in XML format for porting to your practice management system. Through EDIinsight® Task Manager, invalid claims may be assigned to specific users according to error type or other criteria.

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