All tools
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
- • Prior authorization obtained and number on file when required
- • Patient demographics & subscriber/member ID confirmed
- • Primary vs secondary payer (COB) order confirmed
- • Rendering provider credentialed & effective with the payer
- • Most-specific ICD-10 supported by the documentation
- • Every CPT linked to a supporting diagnosis pointer
- • Required modifiers applied; conflicting ones removed
- • NCCI PTP edits run; unbundling only with documentation
- • Units within MUE / frequency limits
- • Claim scrubbed — NPIs, units, all required loops/segments complete
- • Claim history checked for duplicates before sending
- • Submitted within the payer timely-filing window
- • Clearinghouse acceptance / 277CA acknowledgment reviewed