DenialFull Claim Scrubber
Enter all CPT/HCPCS codes, units, modifiers, and ICD-10 diagnoses for a claim. The scrubber checks every code pair for NCCI bundling edits, compares units against CMS MUE limits, validates modifier requirements, and flags potential diagnosis-procedure mismatches.
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What the scrubber checks
NCCI Bundling
Every code pair is checked against CMS NCCI PTP edits. Hard bundles (errors) cannot be overridden. Soft bundles (warnings) require an NCCI modifier.
MUE Unit Limits
Each code's billed units are compared to the CMS Medically Unlikely Edit limit. MAI 2/3 violations are absolute errors; MAI 1 limits may be overrideable.
Modifier Requirements
E&M services billed same-day as surgical procedures are checked for modifier -25. NCCI modifiers are validated on soft-bundle code pairs.
Diagnosis Support
Procedure codes with clear clinical specificity are checked against the ICD-10 diagnoses to surface potential medical necessity mismatches.
Duplicate Codes
Identical CPT/HCPCS codes on separate claim lines are flagged — payers typically reject or deny duplicate codes for the same date of service.
Severity Levels
Errors will likely cause denials. Warnings indicate probable denials with a possible fix. Info items are advisory for compliance and audit readiness.