What it checks
CCI edits. Medicare’s National Correct Coding Initiative pairs, updated quarterly, applied at entry rather than discovered on a CO-97 denial six weeks later.
Payer-specific rules. Each payer can carry its own rules: taxonomy on the claim, modifier preferences, frequency limits, authorization requirements. The rule applies only to that payer.
Modifiers and place of service. A global-capable code in place of service 22 without modifier 26, a 25 on a visit with no separate procedure, a Q6 without a covering physician on file: each is flagged with the reason in plain words.
Radiation oncology frequency rules. 77427 units counted against delivered fractions from Record & Verify; simulation and device codes checked against the course; IMRT planning once per course unless re-planned. The rules were updated for the 2026 code set; how we did it is written up on the blog.
Duplicates. The same service, same date, same patient already on record, flagged before it is denied with CARC 18.
How it works in the day
The scrubber runs as each line is entered, and again when the claim is generated. A line that fails shows the rule and the fix next to the charge. Lines that pass go straight to the electronic claim. Denials that still occur go to a work list sorted by group and reason code, so the practice can see which rules to add.
Frequently asked
When does the claim scrubber run?
As each service line is entered, and again when the claim is generated. A line that fails shows the rule and the fix next to the charge; lines that pass go straight to the electronic claim.
Can the rules differ by payer?
Yes. Each payer can carry its own rules for taxonomy, modifiers, frequency limits and authorization, and a payer rule applies only to claims for that payer.
Does the scrubber include the 2026 radiation oncology codes?
Yes. The rules are maintained by Shavara and updated when the code set changes. For 2026 the deleted delivery, guidance and G-codes are warned at entry, 77387 requires modifier 26 in every setting, and the 77427 fraction count is checked against the new delivery codes.
What happens to a denial the scrubber did not prevent?
It goes to a work list sorted by group and reason code, so the practice can see which payer rule to add and the same denial does not happen again.