Claim Scrubbing Errors

Claim Scrubbing Errors

When you release a claim, the ProviderSuite Claim Manager processes that claim to get it ready for transmission to the payer.

During Claim Manager processing and before sending to the clearinghouse, the claim is "scrubbed" by the ProviderSuite system to check for the following common errors:

Scrubbing Error Type	Scrubbing Error Message
Approved Amount Record	The allowed amount submitted in 2400 AMT02 (0.0000) is less than the paid amount submitted in 2430 SVD02 (14.1500).
Claim Information Record	Incomplete primary payer amounts. Pmts + Adjst + Pt.Resp must equal charges for "CPT".
Claim Information Record	The original primary payer is missing from the current claim and must be added to submit electronically.
Claim Information Record	The patient's signature on file not checked.
Claim Information Record	Bill type Missing.
EPSDT Referral	EPSDT Claim: codes cannot be [Referral Given] with [Not Used].
No Insurance Info for the Destination Payer	Group Number should not equal member number.
Original Reference Number (ICN/DCN) Record	Original Reference Number required if is a corrected claim (Claim indicator=7).
Patient Address Record	Patient Address missing.
Patient Information Record	Patient relationship to insured must be 'self' for Medicaid.
Payer Name Record	Payer Identification Code ID is missing.
Referral Number (REF 9F)	Claims with a referral number must have a Referring Provider.
Rendering Provider Name Record	Supervising Provider Taxonomy missing - select a specialty type for this provider in provider setup.
Subscriber Address Record	Subscriber Address missing

To address a Claim Scrubbing Error, select a claim and review the Claim Scrubbing Error message in the yellow message box in the upper-right corner of the Claim-General tab.

For example, this claim failed claim scrubbing because it was marked as a corrected claim, but it did not have an Original Reference Number listed on the Claim-Final tab.

Based on the particular error, update the claim data accordingly, and re-release the claim.

For the example claim, you could either add an Original Reference Number and re-release or, if it is not a corrected claim, you could remove the corrected claim flag from the claim and re-release.

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