Tailor claim checks to your own workflows and payer-specific needs, catching issues earlier and reducing preventable denials before they ever reach a payer.
As healthcare practices grow, so do the billing challenges: more claims to submit, tighter payer requirements, and rules that vary widely from one payer to the next.
While standard claim scrubbing rules create an important baseline, they don’t account for the required level of complexity that many healthcare practices need. What used to work—a one-size-fits-all approach to claim scrubbing—now leaves gaps that lead to unnecessary rejections and rework.
That’s why we built custom claim scrubbing functionality. Now, you can tailor claim checks to your own workflows and payer-specific needs, catching issues earlier and reducing preventable denials before they ever reach a payer.
Flexible and Comprehensive Claims Validation with RXNT’s New Custom Claim Scrubbing Rules
RXNT’s new custom claim scrubbing rules help reduce rejections and administrative overhead by identifying issues before claims are submitted.
Within the Billing Utilities menu, Billing Managers can define situations where the system should flag claims for further review before submission. If a claim matches the defined criteria, it will be flagged for review, allowing your team to correct the issue before it reaches the clearinghouse.
These new custom rules function as an additional layer of validation that works alongside existing system rules. The standard scrubbing process will continue to run as designed, ensuring baseline compliance and error detection, while your custom rules provide enhanced, organization-specific checks to further improve claim accuracy and reduce submission errors.
A Better Way to Reduce Claim Errors & Rejections
Our new parameter-based validation rules offer more flexibility and workflow personalization in the claim scrubbing process. You can select up to three parameters—with two required—to define the situations in which you want claims to be flagged for further review before submission. Parameters include:
- Payer
- Diagnosis code
- Place of service
- Date of service
- Rendering provider
- Referring provider
- Attending provider
- Purchasing service provider
- Operating provider
- Ordering provider
- Scheduling provider
- Supervising provider
- Billing provider
- Procedure code
- Charge amount
- Patient age
- Patient sex
- Payer priority
For example, you can create a rule like this:
Payer = Aetna
Diagnosis Code = E11.22 & N18.30
Place of Service = Office
This rule would identify any claims matching these parameters and ensure those claims are flagged and reviewed before submission. There’s no limit to the number of rules you can create, so the options are endless and fully customizable to your unique needs!
To get started, head over to the Billing Utilities menu and start creating your own rules. For additional assistance, you can check out our Help Center article.
