RXNT claim scrubbing feature saves you time and helps you get reimbursed quicker. You can quickly set up claims and see all edits at one time. Primary, secondary, or tertiary claims will move automatically to our claim scrubbing queue for additional validation before they go to the clearinghouse and payer. You’ll see the real-time status of your claim and get explicit information about edits and how to correct them.
Send claims
Primary Claim
1. Click on Send Claim/Save Claim on the encounter screen.
2. The system will move the encounter to the Claim Scrubbing (In Progress) tab to perform claim scrubbing. A message saying Scrubbing claim is displayed in the message column, indicating that the claim scrubbing is in progress.
The encounter cannot be accessed from the Claim Scrubbing (In Progress) tab. As soon as the claim scrubbing is complete, the claim is sent/saved successfully if no claim edits are required.
3. If claim edits are required, the encounter will move to the Claim Scrubbing (Corrections) tab.
4. The Corrections column displays the number of edits that are required for each encounter. Hover over the number to find associated corrections in a tooltip.
5. Click on the encounter number.
6. The encounter displays each required claim edit.
7. Make the claim edits and click on the Save button to save the changes.
8. Click Manage Claims to Send claim or Save claim. The encounter moves to the Claim Scrubbing (In Progress) tab and the process is repeated.
Secondary/Tertiary claims
Automatically generated or manually generated secondary/ tertiary claims will go through our claim-scrubbing queue for additional validations before going to the clearinghouse and payer.
1. Access an insurance payment from the Insurance Payment tab.
2. Make sure the Requeue box is checked for the patient to automatically generate secondary/tertiary claims.
3. Select the encounter for which a secondary/tertiary claim should be created.
4. Click on Save and Post.
5. The associated encounter will go to the Claim Scrubbing (In Progress) tab to get converted to a secondary or tertiary claim. As soon as the claim scrubbing is complete and no claim edits are required, the claim is sent successfully. If claim edits are required, the encounter will move to the Claim Scrubbing (Corrections) tab.
The Payer Priority column indicates if the payer is primary/secondary/tertiary.
6. Click on the encounter number in the Claim Scrubbing (Corrections) tab.
7. The encounter displays each required claim edit.
8. Make the edits and click on Save.
9. The claim edits will be displayed on the encounter until you Manage Claims and hit the Send Claim or Save Claim button.
The encounter moves to the Claim Scrubbing (In Progress) tab and the process is repeated.
1. Select 1 or more encounters from the Unbilled tab.
2. Click on Send/Save Claim(s) button.
3. The system will move the encounters to the Claim Scrubbing (In Progress) tab to perform claim scrubbing. The encounter cannot be accessed from the Claim Scrubbing (In Progress) tab.
4. As soon as the claim scrubbing is complete, the claim is sent/saved successfully if no claim edits are required. If claim edits are required, the encounter will move to the Claim Scrubbing (Corrections) tab.
The Corrections column displays the number of edits that are required for each encounter.
5. Click on the encounter number in the Claim Scrubbing (Corrections) tab.
The encounter displays each required claim edit.
6. Click Save to save the changes.
7. Click Send claim or Save claim. The encounter moves to the Claim Scrubbing (In Progress) tab and the process is repeated.
Remove encounters
If an encounter is in the Claim Scrubbing (Corrections) tab but does not require further action, you can remove it from the queue by selecting the encounters and clicking Remove Checked. This will place the encounter in the tab corresponding to its status.
Claim limits
Some clients have opted for billing subscriptions with claim limits for each provider. When a provider hits the claim limit for the month, the encounter will be added to the Claim Scrubbing (Corrections) tab.
When claim limits are reached, you have two options:
- Wait until the 1st of the following month to send claims when the provider's claim count resets
- Contact Sales at sales@rxnt.com or 1-800-943-7968 and request to upgrade your subscription
Once you have available claims, you can continue billing the encounters from the Claim Scrubbing (Corrections) tab. Once in the Claim Scrubbing (Corrections) tab, you will see two encounter statuses: New Encounter and Sent To Payer.
1. New Encounters do not have any associated claims.
2. When you click into the encounter, simply choose to Send Claim or Save Claim. This will remove the encounter from the Claim Scrubbing (Corrections) tab and send the claim.
1. Sent to Payer encounters have claims previously associated with the encounter.
2. This typically happens for secondary and tertiary claims, but you may see this after resubmitting a rejected claim or after resubmitting a claim from the Pending tab. When this happens, you have a few workflow options available:
- You can resend the claim via the Claims module, most likely from the Pending or Rejected tab. This will resend the claim and remove the encounter from the Claim Scrubbing (Corrections) tab.
- You can navigate to the Claim Scrubbing (Corrections) tab, select the encounter, manage claims, and resubmit the claim. This will resend the claim and remove the encounter from the Claim Scrubbing (Corrections) tab.
3. In some cases, you may not need to resend the claim at all. When this happens, check the box beside the encounters and click the button to Remove Checked. This will remove the encounter from the Claim Scrubbing (Corrections) tab and the encounter will be updated to the previous status.
Helpful tips
- Encounters with the status "Claim Scrubbing (In Progress)" cannot be edited.
- To optimize workflow, clicking Send claim or Save claim will navigate you to the Encounters screen where charges can be easily added.
- Clicking Send claim or Save claim from any screen will launch the new claim scrubbing process.
- Receiving this error: "Claim scrubbing was not completed for this encounter. Send or save claim again."? This means a system error occurred during the claim scrubbing process. Click Send or Save Claim again.
- If the case is changed to Self Pay for any encounter in the Claim Scrubbing (Corrections) tab, the associated encounter will automatically move to the Billed tab and claim validation messages will be cleared.
- Releasing (12/14/2022) - When the CHC timeout issues occur (which means CHC did not acknowledge that they received the claim), the encounter will get sent to the Billed tab, and the associated claim will have the status "Errored" with the message "RXNT did not receive confirmation from ChangeHealthcare that this claim was received. Please resubmit this claim."
If we receive new status from Change Healthcare, the error and the status are removed and updated accordingly.
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