Scrubber Errors-How to Correct and Rebuild Claim
If the Scrubbing process finds a claim with errors/incomplete information, a Scrub Error message will pop up and the claim will automatically be moved to the On Hold section of Claims Manager.
This lesson will describe the errors and list the steps to correct the error(s). The Claim will then have to be Rebuilt to apply the corrections, and Scrubbed again. When the claim has passed the scrubbing process, it will be automatically moved to the Ready to Submit section.
Note: Edits/Corrections will not be applied to claims unless the Rebuild process is performed.
Scrub Errors
1. Click the OK button in the message box.
2. In the On Hold section of the Claims Manager, Double Click anywhere on the claim line to open Patient Account and make corrections as listed in the following steps.
After corrections are made, Close the Patient Account, return to Claims Manager and Rebuild claim to apply changes.
Patient is missing part of their demographics- Invalid Date of Birth
Verify patients demographics are correct: date of birth, address, phone, etc.
3. Click the Demographics Tab.
4. Correct the Birth Date.
Return to Claims Manager and Rebuild claim to apply changes.
The Primary insured is missing part or all of their demographics
Verify insured info
1. Find the claim getting rejected in the On Hold section of Claims Manager and Double Click inside the grid to open Patient account. Click the Insurance tab.
2. Click View next to the insurance company getting the error
3. Check each field in the Insured Information section and verify that it matches information exactly as it appears on insurance card, including the Patients relation to insured.
Return to Claims Manager and Rebuild claim to apply changes.
Primary Insurance Company Missing Data
Check Insurance Company setup
1. Find the claim getting rejected in On Hold section of Claims Manager and find the Payer name-Primary column or Secondary column, depending on filing status
2. Go to Tools -> Insurance Company.
3. Find the Insurance Company/Payer within the list and Click the Edit Icon.
4. Add missing info.
5. Click OK
Return to Claims Manager and Rebuild claim to apply changes.
Secondary Insurance Company Missing Data
Check Insurance Company setup
1. Find the claim getting rejected in On Hold section of Claims Manager and find the Payer name-Primary column or Secondary column, depending on filing status Go to Tools -> Insurance Company.
2. Find Insurance Company in Insurance Company Manager and Click the Edit Icon.
3. Add missing info.
4. Click OK
Return to Claims Manager and Rebuild claim to apply changes.
The line items are missing part or all of their detail-CPT/HCPCS Code
Edit Charge Details
1. Find the claim getting rejected in On Hold section of Claims Manager and Double Click inside the Grid to open Patient Account.
2. From the Claims tab, click the claim getting the error to open it in Claim Details.
3. Double Click on the line item to open the Charge Details.
4. Add appropriate Codes in the Code field. Repeat for each line item in Claim Details section.
5. Click Save.
Return to Claims Manager and Rebuild claim to apply changes.
The line items are missing part or all of their detail-Units
Edit Charge Details
1. Find the claim getting rejected in On Hold section of Claims Manager and Double Click inside the Grid to open Patient Account.
2. From the Claims tab, click the claim getting the error to open it in Claim Details.
3. Double Click on the line item to open the Charge Details.
4. Add appropriate number in the Units field. Repeat for each line item in Claim Details section.
5. Click Save.
Return to Claims Manager and Rebuild claim to apply changes.
The Provider is missing part or all of their information
Verify Rendering Provider information in Provider Manager
1. Find the claim getting rejected in the On Hold section of Claims Manager and Check for Provider name in the Provider column.
2. Go to Tools -> Provider Manager and verify correct info is entered in all fields.
3. Add missing data and Click Update.
If there is not a Provider shown in the Provider Column, see next step
The Provider is missing part or all of their information-No Provider selected
1. Double Click on the line of the claim getting the error to open the Charge Details.
2. From the Claim Details, double click on the claim getting the error to open the Charge Details.
3. Use the drop down list to add the Rendering Provider in the Provider field.
4. Repeat for each line item on the claim.
Return to Claims Manager and Rebuild claim to apply changes.
The Referring provider is missing part or all of the information
Verify Referring Physician info is entered correctly in Contacts
1. Find the claim getting rejected in the On Hold section of Claims Manager and Double Click inside the grid to open Patient account. Click the Demographics tab.
2. Check the name of the Referring Provider.
3. Go to Tools -> Contacts and Click to highlight/select Referring Provider from the list.
4. Click the Edit icon to Edit Contact Information.
5. Verify Provider information is included in each required field. Name and NPI numbers are required
Return to Claims Manager and Rebuild claim to apply changes.
The Provider is missing all or part of the signature
Verify Rendering Provider Signature is loaded
1. Find the claim getting rejected in the On Hold section of Claims Manager and check the Physician column to find the name of the Rendering Physician.
2. Go to Tools -> Provider Manager and select that physician from the list of Providers.
3. Click on the Signature tab and make sure signature is selected. (See Provider Manager setup in Billing Maintenance)
4. Click Update.
Return to Claims Manager and Rebuild claim to apply changes.
The Facility is missing part or all of its address information
Verify POS/Place of service
1. Find the claim getting rejected in On Hold section of Claims Manager and Double Click inside the Grid to open Patient Account.
2. From the Claims tab, make sure the rejected claim is displayed in Claim Details and Double Click to open the Charge Details.
3. Add the correct Facility in the Misc. Details section of Charge Details dialog.
4. Click Save.
5. Repeat for each line item on the claim.
Return to Claims Manager and Rebuild claim to apply changes.
The Facility is missing part or all of its information
Check Facility Setup
1. Find the claim getting rejected in On Hold section of Claims Manager and Double Click inside the Grid to open Patient Account.
2. From the Claims tab, make sure the rejected claim is displayed in Claim Details and Double Click to open the Charge Details.
3. Check the Facility in the Misc. Details section of Charge Details dialog as shown in the previous step.
4. Go to Tools -> Manage Facilities and select the Facility from the list.
5. Click the Edit icon.
6. Verify required information, including Facility NPI# is in facility Details tab.
7. Click Update to save changes.
Return to Claims Manager and Rebuild claim to apply changes.
When a diagnosis is between 800 and 999.9, Accident info is needed
Add accident information to More Info dialog
1. Find the claim getting rejected in On Hold section of Claims Manager and Double Click inside the Grid to open Patient Account.
2. Verify the rejected claim is displayed in Claim Details (bottom section) of the Claims tab.
3. Click the More Info button.
4. Add the Type of Accident in Edit Claim Details dialog
5. Add the Date of Illness, Injury or Pregnancy.
6. Click Save.
Return to Claims Manager and Rebuild claim to apply changes.
When auto accident is selected a state must be selected
Add accident State and/or Date of Current to More Info dialog
1. Find the claim getting rejected in On Hold section of Claims Manager and Double Click inside the Grid to open Patient Account.
2. Verify the rejected claim is displayed in Claim Details (bottom section) of the Claims tab.
3. Click the More Info button.
4. Click on the drop down list and select State in which the accident occurred.
5. Click Save.
Return to Claims Manager and Rebuild claim to apply changes.
At least one diagnosis must be entered for the charges.
Add diagnosis code(s) to claim
1. Find the claim getting rejected in On Hold section of Claims Manager and Double Click inside the Grid to open Patient Account.
2. From the Claims tab, verify the rejected claim is displayed in Claim Details (bottom section) and Double Click the claim to open Charge Details dialog.
3. Click Add Code in the Diagnosis Codes section.
4. Click Save.
5. Repeat for each line item on the claim.
Return to Claims Manager and Rebuild claim to apply changes.
A Charge information is missing or incorrect
Verify correct date of service is associated with charges
1. Find the claim getting rejected in On Hold section of Claims Manager and Double Click inside the Grid to open Patient Account.
2. From the Claims tab, verify the rejected claim is displayed in Claim Details (bottom section) and Double Click the claim to open Charge Details dialog.
3. Edit/Add the correct date of service in the Service From and Service To fields.
4. Click Save.
5. Repeat for each line item on the claim.
Return to Claims Manager and Rebuild claim to apply changes.
The line item is missing all or part of their information
Verify Rendering Provider setup includes NPI information
1. Find the claim getting rejected in the On Hold section of Claims Manager and check the Physician column to find the name of the Rendering Physician.
2. Go to Tools -> Provider Manager and select the physician from the list of Providers.
3. Click the General tab and verify correct NPI is entered in the Physician numbers section.
Return to Claims Manager and Rebuild claim to apply changes.
Missing/Invalid Taxonomy Code
Verify Taxonomy Code in setup
In the On Hold section of the Claims Manager, find the claim with the error and check the Physician column to find the name of the Rendering Physician
1. Go to Tools -> Insurance Companies.
2. Highlight the Insurance company rejecting the claim.
3. Click the Edit Insurance Company icon
3. Click the Rendering/Performing Provider from the list in the Provider Setup section.
4. Click the Edit icon to open the Edit Billing Information dialog.
5. If the Group Taxonomy is missing, make sure the Legacy ID in the insurance Payment To section has Provider Taxonomy-ZZ and that the correct Taxonomy Code is entered.
6. For the Rendering Provider rejection, verify that the Legacy ID is Provider Taxonomy-ZZ and that the correct Taxonomy Code is entered in the Rendering Information section. For a list of Taxonomy Codes Click on the link below.
http://www.wpc-edi.com/content/view/793/1
Return to Claims Manager and Rebuild claim to apply changes.
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