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
Claim #841 was scrubbed and rejected because it was missing a diagnosis code for CPT code 99215.
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.
Patient account will open to the Claims tab with the active claim shown in the bottom section. Corrections can be made by clicking on any of the tabs, depending on what the scrub error indicates.
After corrections are made, Close the Patient Account, return to Claims Manager and Rebuild claim to apply changes.
At least one diagnosis must be entered for the charges: No Diagnosis entered for 99215
1. Double click on the line item that's missing info to open Charge Details dialog
At least one diagnosis must be entered for the charges: No Diagnosis entered for 99215 (continued)
2. Click Add Code in Diagnosis Codes section
3. Type code or use drop down to search by code or description
4. Click Select and Save
Close patient account and return to Claims Manager. Select claim from On Hold section and click Rebuild.
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
For step by step Insurance Company setup instructions, click here
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
For step by step Insurance Company setup instructions, click here
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 of units in the field.
5. Click Save.
6. Repeat for each line item in Claim Details section.
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 code in the field.
5. Click Save.
6. Repeat for each line item in Claim Details section.
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.
4. Verify Provider is linked to Billing/Group information.
5. Verify Signature is added.
6. 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. Click Save.
Repeat for each line item in Claim Details.
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 select the Referring Provider from the list. Double click to Edit Contact Information.
4. Verify Provider information is included in each required field.
5. If additional provider IDs are required, add the insurance company requiring the ID and enter that information.
6. Click OK to save information.
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 Facility. If Facility is already added, check the Facility Setup to verify information is correct.
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.
Facility Information
6. Verify required information is included in each field. (Include 9 digit Zip Code)
7. If Additional IDs are required, click the Additional IDs tab and enter required information.
7. Click Update to save changes.
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.
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.