What is Claim Scrubbing?
Also called: claim scrubber · pre-submission edits
A scrubber checks the mechanical failures first: invalid or terminated codes, missing modifiers, diagnosis-to-procedure mismatches, NCCI bundling conflicts, medically unlikely edit violations, missing referring provider NPI, demographic and policy number mismatches.
The economics are unambiguous. Correcting an error in the scrubber costs minutes. Correcting the same error after denial costs an average of $57.23 per claim according to Premier's 2023 analysis, plus 30 to 60 days of delay, plus the risk of missing a timely filing deadline entirely.
Where Vizora handles this
Primary sources
Where "Claim Scrubbing" is defined by the bodies that set the rules, rather than by us.
- CMS-1500 claim form standards (opens in a new tab)
National Uniform Claim Committee — Maintainer of the CMS-1500 professional claim form and its data element definitions, plus the provider taxonomy code set.
- Medicare Claims Processing Manual (opens in a new tab)
Centers for Medicare & Medicaid Services — The operative manual for how Medicare claims must be coded, submitted, adjusted and appealed. When a payer policy and a vendor's advice disagree, this settles it.
- CAQH Index: cost of administrative transactions (opens in a new tab)
CAQH — Per-transaction cost of eligibility checks, claim status inquiries and prior authorization, manual versus electronic. The best public evidence for automating front-end work.
Last reviewed August 20, 2026
Related terms
Clean Claim
A clean claim is a claim that passes payer adjudication and is paid on first submission, without rejection, denial or a request for additional information. Clean claim rate — the percentage of claims meeting that standard — is the most direct measure of whether a billing operation is working.
NCCI Edits
National Correct Coding Initiative edits are CMS-published rules preventing improper code pairings. Procedure-to-procedure edits stop two codes being billed together when one is a component of the other; medically unlikely edits cap the units of a code reportable for one patient on one day.
Clearinghouse
A clearinghouse is an intermediary that receives claims from providers, validates and reformats them into each payer's required electronic standard, and routes them onward. It also returns acknowledgements, rejections and electronic remittance advice, acting as the single connection point to hundreds of payers.
Denial
A denial is a claim the payer adjudicated and refused to pay. It differs from a rejection, which never entered adjudication. That distinction determines your remedy: a rejected claim is corrected and resubmitted, while a denied claim must be appealed within the payer's deadline.
More in Claims and submission
Find out what your denials are costing you
A free billing audit reviews your denial rate, AR aging and clean claim rate against industry benchmarks. Takes about two minutes to request. No sales pitch.
No setup fees · You pay when we collect · Pricing from 3% of net collections