Claim scrubbing
Automated and manual review against payer rules to catch errors pre-submission.
Claims Submission
Claim Scrubbing and Electronic Submission
Clean claims are cheaper than corrected ones. RCM Nexa validates claims against payer edits before submission and tracks every acknowledgement so nothing disappears at the clearinghouse.
Overview
Why this work decides whether you get paid
Submission is not a send button. Between your system and the payer sit clearinghouse edits, payer-specific formatting rules, attachment requirements and acknowledgement files that most practices never read — which is where quiet rejections go to age.
RCM Nexa scrubs claims against payer edits before transmission, monitors clearinghouse and payer acknowledgements daily, and corrects rejections within hours so timely-filing exposure does not accumulate invisibly.
Who this is for
- Practices with unexplained gaps between billed and acknowledged claims
- Providers writing off claims to timely filing
- Organizations billing many payers with differing edit rules
- Teams needing attachment-heavy or secondary claim handling
What this includes
- Payer-specific edit checks before submission
- Electronic submission with acknowledgement tracking
- Same-cycle rejection correction
- Secondary and tertiary claim handling
Submission monitoring
Clearinghouse and payer acknowledgements reconciled against submitted batches.
Rejection workflow
Front-end rejections corrected and resubmitted quickly, with reasons logged for trending.
Coordination of benefits
Secondary and tertiary claims filed with the correct primary payment details attached.
How We Run It
Our claims submission workflow
A defined sequence with named ownership at every handoff, so accountability does not disappear between steps.
Scrub
Claims are validated against payer-specific and clearinghouse edits before anything is transmitted.
Transmit
Primary, secondary and paper-required claims are submitted through the correct channel with required attachments.
Confirm receipt
Acknowledgement and rejection reports are worked daily so every claim reaches an accepted status.
Correct fast
Rejections are corrected and resubmitted quickly, with recurring edit failures fixed upstream.
Common Problems
What usually goes wrong — and how we handle it
Rejections are mistaken for pending claims
Acknowledgement reconciliation distinguishes accepted, rejected and never-received claims explicitly.
Secondary claims are never filed
Coordination-of-benefits claims are queued automatically once primary remittance posts.
Attachments are missing
Attachment requirements are identified per payer and policy before submission.
Common Questions
Questions we get asked about claims submission
- Do we keep our clearinghouse?
- Yes. We work with your existing clearinghouse and payer connections wherever possible.
- How are rejections tracked?
- By reason code and payer, so recurring causes get fixed upstream in coding or charge entry.
Related Services
Often engaged together
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Learn MoreNext Step
Talk to an RCM expert about your revenue cycle
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