Who this is for: All Barti users who review and submit insurance claims.
What is claim scrubbing?
Claim scrubbing is a pre-submission review to catch errors that will cause denials or rejections before the claim ever reaches the payer. A few minutes of scrubbing saves hours of rework.
Scrubbing checklist
Check | Why it matters |
Diagnosis supports the procedure (medical necessity) | Payers deny claims where the diagnosis doesn't justify the service. For example, a fundus photo billed with a refractive-only diagnosis will be denied. |
No refractive diagnosis codes (H52.x) on Medicare claims | Medicare does not cover refractive services. Any H52.x code on a Medicare claim triggers an automatic rejection. |
Referring provider NPI is present for all diagnostic tests and imaging | Required by most payers — even when the referring and rendering provider are the same person. Absence is one of the most common denial causes for imaging and ancillary testing. |
Payer ID is correct | The payer ID is the claim's mailing address. Wrong payer ID = claim goes to the wrong payer or rejects immediately. Verify against the back of the insurance card. |
ICD-10 codes are current and specific | Outdated or non-specific codes cause rejections. Use the most specific valid code available. |
CPT codes are linked to the correct ICD-10 diagnosis codes | Unlinked codes may not transfer to the claim correctly. |
Modifiers are added where required | Post-op global period claims, bilateral procedures, and assistant surgeon claims all require the appropriate modifier. |
Insurance responsibility column has a dollar amount > $0 | If the full charge is sitting in the patient responsibility column, insurance has nothing to pay and the claim may produce no reimbursement. |
Separate invoices for services going to different payers | If an exam goes to medical and materials go to VSP, those must be on separate invoices — and therefore separate claims. |
All charges for the visit are finalized | Do not submit a claim until the invoice is complete. Changes after submission trigger the orange exclamation point (!) warning at payment posting. |
Post-op claim includes the correct modifier and original surgeon | Post-op global period claims require the correct modifier and the original surgeon's information on the claim. |
Common rejections that scrubbing prevents
Rejection | Root cause | Fix before submitting |
Medical necessity denial | Diagnosis doesn't support the procedure | Update ICD-10 code or add a supporting medical diagnosis |
Medicare refractive rejection | H52.x code on claim | Remove all refractive diagnosis codes from Medicare claims |
Missing referring provider | NPI not explicitly entered | Add referring provider NPI — even if same as rendering |
Wrong payer | Incorrect payer ID | Verify payer ID on insurance card and update patient profile |
Payer enrollment pending | EDI not completed for this payer | Complete ERA enrollment in TriZetto before submitting |
Fundus / imaging denial | No medical diagnosis linked to imaging code | Link a medical diagnosis (not refractive) to the imaging CPT |