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Advanced Claims Scrubbing Software

Integrated clinical editing and claims scrubbing software from the trusted name in healthcare – 1st Providers Choice.

Using 1st Providers Choice's electronic claims processing software with built-in claims scrubbing capabilities, providers can submit clean claims the first time, reducing rejections and denials and increasing revenue. Our front-end claims editing solution integrates directly into your clearinghouse workflow, helping payers improve the accuracy of claims payments and lower administrative costs without having to change existing adjudication processes.

clinical editing workflow

Features and benefits

  • Streamline claims processing workflows
  • Maintain timely compliance with industry rules and regulations
  • Identify missed revenue opportunities through positive edits
  • Increase physician and member satisfaction
  • Actively track, control and prevent denied claims
  • Provide an automated and consistent standard for compliance
  • Slash inconsistent manual review and reallocate your resources
  • View multiple claims rules on the same screen
  • Reduce claim denials by pre-screening for billing and coding errors
  • Realize significant ROI through intelligent automation

Contact us to learn how your organization can benefit from our advanced claims scrubbing software.

A comprehensive and customizable clinical editing solution for physicians

Our advanced claims scrubbing software can be customized by facility, employer, and payment methodology. You can also modify rules to reflect your unique program design and tailor the application with date-sensitive auditing logic. These features help you catch errors, omissions, and questionable coding automatically.

While basic claims scrubbing systems might check that certain fields are filled out on a claim, our clinical editing software also verifies the accuracy of the entered data before the claim is submitted to the payer. This includes patient demographics, insurance information, procedure and diagnosis codes, and date of service. Through automated alerts, staff can be notified when edits are necessary. You also have the possibility of reviewing the guidelines and regulations that may have triggered the alerts.

Our software uses the same tools that major insurance carriers rely on. This means that if a payer's tool is updated your practice gets the same update as well. These automatic updates allow you to identify errors that an insurance carrier might catch, thus avoiding denials and delays in payment. In addition, our advanced claim editing solution is sourced from a comprehensive commercial and Medicare knowledge base that contains more than 81 million government and third-party industry edits, and is updated quarterly and biweekly with NCD/ LCD updates.

Advanced clinical editing edit examples:

  • Age, gender, frequency relationships
  • Appropriate use of modifiers
  • Commercial unbundle edits
  • CPT® codes to DX to modifier relationships
  • Medicare edits (MUE, globals, reductions)
  • Medicare unbundle (CCI)
  • NCD/LCD Sequencing of DX codes

For more information about our EMR integrated, ICD-10-ready claims scrubbing software, call 480-782-1116.