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Insurance CIO Outlook | Wednesday, August 26, 2026
As a result of claim scrubbing, it is possible to make more accurate claims, improve relationships with clients and facilitate better relationships with patients.
FREMONT, CA: Claims scrubbing involves finding and eliminating coding errors on medical claims before they are submitted to insurers. Whether automated or manual, claim scrubbers verify medical claims before they are submitted to payers.
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Understanding how medical revenue works is essential to understanding claim scrubbing:
Bills are submitted by providers.
These bills are coded into concise reports by medical coders.
For insurers, medical billers fill out CMS-1500 and UB-04 forms.
Depending on the size of their organization, medical billers receive hundreds to thousands of bills every day, and they have little time to review the accuracy of their reports. Medical billers must repeat the entire process if a claim is denied or suspended because of an error, causing cash flow problems and increasing overhead costs.
Scrubbers are usually part of third-party medical billing services. Medical bills must be audited to ensure accuracy. Hospitals, dentists, doctor's offices, and outpatient centers all use scrubbers. While some scrubbers check that form fields are filled in, others perform a meticulous audit.
What is the purpose of a claim scrubber?
There are two types of claim scrubbers: those that audit for complete information and those that audit for accuracy. After reports have been created and are ready to submit, but before they are submitted to insurers, both types of claim scrubbers check for errors. Claims scrubbers flag mistakes for medical coders or billers to fix.
Another term to hear is "charge scrubber." Charge scrubbers are similar to claim scrubbers. In contrast to claim scrubbers, charge scrubbers audit medical billing reports before they are submitted to insurers.
Charge scrubbers flag billing errors before claims are created, while claim scrubbers flag them after claims are created.
The Advantages of claim scrubbers: Some of the crucial advantages of claim scrubbers are explained below:
Claims that are accurate: As a result, insurers receive accurate claims the first time around, resulting in fewer denials and easier reimbursements.
Relationships with clients have improved: Patients who make timely payments are more likely to remain with the medical practice.
Business tasks can be completed with more time: As a result of a smoother billing process, the organization and its employees will be able to devote more time to marketing, patient care, and research.
A better relationship with payers: In addition to receiving meticulously accurate reports, payers spend less time and effort rectifying faulty claims, resulting in a reduction in overhead costs.
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