Payers

Claims and Credentialing Done Right.

Confirm provider eligibility, review claims for medical necessity, flag outliers, validate correct coding, bundling, and pricing. Return clear adjudication messages, and use our Dashboard to identify areas of risk, utilization trends, initiate focused audits, and develop education campaigns.

Claims Management made sensible.

How ClaimScrubTM Helps You

  • Inpatient, Outpatient, Specialty Claim Adjudication
  • Support for Medical Necessity / Coverage policies, based on Medicare, Medicaid, Private Payers, or your own plan provisions
  • Speed Up Processing Time
  • Prevent Dollars Lost on Inappropriate Care – even for small claims
  • Facilitate the most appropriate patient care
  • Reduce patient out-of-pocket expense from inappropriate services and coding
  • Reduce provider phone calls with clear remittance messaging and Context-Based Links
  • DashBoard Provides Insight into Trends, Benchmarks, and Opportunities
  • Average 10,000 Changes per Week to Coding and Coverage Rules – We’re on Top of Them Every Day with a nationally certified content team that curates every change
  • Tested constantly by thousands of client sites across every specialty

ClaimScrub does the Impossible, so you can do the Important

  • Custom Edit Engine for plan-specific exceptions
  • Establish Custom Edits or Modified Rules for Specific Clients or Provider Types
  • Custom Edits are Fully Integrated, Fully Documented, and Fully Transparent
  • Most Nuanced and Complete Rule Engine Available
  • Easy to Use

Don’t Let Dollars Slip Through the Cracks

  • Historical Edit module tracks care, coding and coverage across time, providers, and multiple claims
  • Identify issues with bundling, 3-day rule, post-op periods, related care episodes, duplicate billing, split claims
  • Medicare Reference Pricing Combines Transparent and Standardized Payment Methodologies With Plan-Specific Reimbursement Levels and Coverage Policies to Create Sustainable Claims Processes

Exclusion and Sanction Checking Made Simple.

EPStaffCheckTM Credentialing Service

  • Identify sanctioned/excluded providers prior to payment
  • Verify license status
  • SSDI (Social Security Death Index) matching prevents provider/patient identity theft and misappropriated claims
  • Screen out-of-network providers
  • Maintain panel integrity with continuous credentialing and disciplinary action monitoring

Use ClaimScrub To:

  • Confirm Provider Eligibility

  • Review Claims For Medical Necessity

  • Validate Correct Coding, Bundling, And Pricing

  • Return Clear Adjudication Messages

  • Flag Outliers

Why Choose ClaimScrub? 

Because claims done right are Justice for all.

Payers, Providers, and Patients.

Stewardship of premium dollars, reserves, and protecting patients from inappropriate out-of-pocket expenses. Claims Done Right. How can we help you?