Clean-Claim Scorecard
First-pass acceptance is the cheapest revenue you have. Check the controls your workflow actually runs — each gap shows the denial it invites.
Front-end
Coding
Submission
Clean-claim readiness
0/100
High denial risk
14 open gaps
• Eligibility & benefits verified for the date of service
Resolve with Eligibility Verification →• Prior authorization obtained and number on file when required
Resolve with Auth Appeal Generator →• Patient demographics & subscriber/member ID confirmed
Resolve with ERA 835 Decoder →• Primary vs secondary payer (COB) order confirmed
Resolve with Denial Lookup →• Rendering provider credentialed & effective with the payer
Resolve with Provider Credentialing →• Most-specific ICD-10 supported by the documentation
Resolve with Appeal Generator →• Every CPT linked to a supporting diagnosis pointer
Resolve with NCCI Scrubber →• Required modifiers applied; conflicting ones removed
Resolve with Modifier Validator →• NCCI PTP edits run; unbundling only with documentation
Resolve with PTP Scrubber →• Units within MUE / frequency limits
Resolve with Fee Benchmarker →• Claim scrubbed — NPIs, units, all required loops/segments complete
Resolve with 835 Decoder →• Claim history checked for duplicates before sending
• Submitted within the payer timely-filing window
Resolve with Timely Filing Matrix →• Clearinghouse acceptance / 277CA acknowledgment reviewed
Turn these Clean-Claim Scorecard insights into a practice-specific review
Found gaps in your front-end intake or coding controls? Aethera can review your claim controls and agree measurable service targets in writing. Let our senior AAPC-certified billing team audit 50 of your active claims or past denials — completely free. Results in 14 days after the BAA, complete intake and agreed success criteria.
Test our scrub rules and appeal workflow on 50 real claims. Zero commitment, no credit card required.
Enter your aging totals for an instant planning report. Uploaded files are processed locally; clinical intake is arranged separately.