Claim Scrubbing Overview |
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When processing submission files, we recommend you follow these steps in the order below for an easy and successful implementation of ClaimStaker.
There are two ways to upload and process submission files using Alpha II ClaimStaker: through your vendor or through ClaimStaker. The main differences between the two modes are how your files are submitted to ClaimStaker for scrubbing and how you view or receive the resulting Claims in Error reports.
If you license ClaimStaker through your practice management software vendor and have questions about the mode that has been implemented for you, or for instructions on processing files, please contact your vendor.
Instructions for processing files through ClaimStaker are available from the File Upload and File Download pages.
The Claims in Error report is the result of processing (scrubbing) a submission file. The report displays each claim that has one or more edits applied and provides easy-to-understand messages to help you decide whether or how to correct the claim. You may wish to print the Claims in Error report and return to your practice management system to thoroughly review each claim. It may also be necessary to obtain other source documents and medical records to make a final decision on the appropriate corrective action.
The edit configuration options available in ClaimStaker allow you to control the edits that are applied to your claims. There are many edit configuration options available; however, our help desk personnel have preset an initial configuration for you. This configuration was based on your specialty and the sample submission file that you provided. Our help desk personnel are very knowledgeable about all edits offered, so from the very first file scrubbed, you will see the benefits of using our initial edit configuration settings.
Once you've reviewed several Claims in Error reports and monitored your claim rejections and denials, you will be able to fine tune the edit configurations to best meet your needs. But we highly recommend that you do not try to pre-configure these settings. It is much more effective to adjust your edit configurations after you have reviewed a few Claims in Error reports and have a better understanding of how edits affect your reports.
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