Try our live Medical Claim Scrubber

What the Claim Scrubber Evaluates

Most claim errors are not caused by a single wrong code. They happen when the elements of a claim — procedure codes, modifiers, diagnoses, place of service — interact in ways that conflict with payer rules or coding guidelines. This tool evaluates those relationships, not just individual fields.

Specifically, the scrubber reviews:

• CPT, HCPCS, and J-codes for validity and compatibility with the other elements on the claim
• Modifiers for correct application, missing entries, and conflicts that affect how services are interpreted
• ICD-10 diagnosis codes for alignment with the procedure billed and support for medical necessity
• NDC entries for drug-related claims where applicable
• Place of service for consistency with the codes and modifiers submitted
• Code relationships across lines, including NCCI bundling conflicts between panel codes and their components

The demo version of PGM's claim scrubber reflects common denial drivers and coding relationships. It omits payer-specific and eligibility logic, which PGM applies within full billing engagements.

Common Errors This Tool Catches

Pre-submission validation surfaces issues that are easy to miss when reviewing codes individually. Some of the most common patterns:

• Modifier conflicts — An E/M code billed on the same date as a procedure without modifier 25, or a bilateral procedure missing modifier 50. Each code may appear valid in isolation; the conflict only becomes visible when they're evaluated together.
• NCCI bundling errors — A comprehensive panel code submitted alongside individual component tests that are already included in the panel by definition. Payers will deny the component codes; the scrubber flags the conflict before submission.
• Diagnosis-to-procedure mismatches — A treatment-level service code paired with a screening or administrative diagnosis that doesn't support medical necessity. Common in behavioral health and GI billing, and one of the more difficult errors to catch manually at volume.
• Place-of-service inconsistencies — A code or modifier combination that doesn't align with the place of service entered, which can trigger payer edits even when the coding itself is otherwise correct.

Who Uses Claim Scrubbing

Claim scrubbing tools are used across the revenue cycle — by billing teams, physician practices, laboratories, ambulatory providers, and anyone responsible for submission accuracy before claims reach a payer.

The error types that surface differ by setting. Physician practices tend to encounter modifier conflicts and E/M bundling issues. Laboratories deal frequently with NCCI bundling between panel and component codes. Behavioral health providers often see diagnosis-to-procedure mismatches tied to medical necessity. The scrubber evaluates the specific combinations in each claim, so the output reflects the actual coding context.

PGM provides full-service billing and revenue cycle management for physician practices and laboratories. If pre-submission validation is surfacing recurring patterns in your claims, that's often a signal worth examining across the full revenue cycle. Contact us to learn more.

Beyond the Claim Scrubber Demo

The tool above illustrates how pre-submission validation works against common denial drivers. PGM's full billing and RCM services apply this logic at scale — across claim volume, payer mix, and specialty-specific coding requirements — with certified coders and account management behind every submission.

If you're seeing denial rates you'd like to understand better, or if you want to know how your clean-claim performance compares to benchmarks, reach out to PGM. The conversation starts with your current situation, not a sales pitch.