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 recovered cash
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Upload your aging report for instant benchmark comparisons against MGMA standards and recoverable cash projections.