Billing Fundamentals/Intermediate/16 minutes/Reviewed 2026-07-10

Clean Claim Scrubbing Checklist

Build a repeatable pre-submission review that catches demographic, provider, coding, authorization, and coordination errors.

Quick answer

A clean-claim review tests whether the claim can pass format edits and whether its facts agree: person, payer, provider, service, diagnosis, setting, authorization, units, documentation, and COB.

Rules to know

Run eligibility and payer-order checks for the date of service.
Validate provider enrollment, NPI, taxonomy, and location relationships.
Check code combinations, units, modifiers, POS, and policy edits.
Treat authorization and documentation as linked controls, not separate checkboxes.

Operational workflow

01Validate identity and coverage without copying PHI into unapproved tools.
02Confirm provider, location, enrollment, and payer routing.
03Check diagnosis-to-service, modifier, POS, units, and NCCI relationships.
04Match authorization scope and dates to the billed service.
05Release only after errors have a named owner or documented exception.

Common failure modes

Relying on a single generic scrubber rule set.
Ignoring payer-specific contract and portal requirements.
Failing to confirm that corrected errors reached the final transmitted claim.

Knowledge check

A clean claim is best described as what?

Any claim accepted by a clearinghouseA claim that needs no external prepayment developmentA claim with a high chargeA paper claim

Official sources

Electronic Health Care ClaimsCenters for Medicare & Medicaid ServicesReviewed 2026-07-10 Medicare Claims Processing Manual (Publication 100-04)Centers for Medicare & Medicaid ServicesReviewed 2026-07-10 Complying with Medical Record Documentation RequirementsMedicare Learning NetworkReviewed 2026-07-10

Continue this track

FoundationThe Medical Billing Claim Lifecycle FoundationICD-10, CPT, and HCPCS: What Each Code System Does FoundationHIPAA Privacy and Minimum-Necessary Billing Workflows

Education only. Verify the current code set, payer contract, coverage policy, implementation guide, and claim-specific facts. Do not enter protected health information into this site.