Built to catch the denial before you submit it, and the upcode before an auditor does.
Clean-Claim Scrubber checks every claim in both directions before it leaves: the errors and edit violations that get you denied, and the aggressive codes that get you audited. Risky claims go to a human instead of quietly through, the defensible code gets selected (not undercoded, not padded), and every claim leaves with an audit-defense record attached, written while the coding decision is fresh.
Scrub last month's claims and see what it catches See a sample scrub report
THE PROBLEM
Every billing team knows the two failure modes, and most tools only guard one of them. Submit a claim with a missing modifier or a mismatched code and the denial comes back in thirty days, which is thirty days of cash you floated for a clerical error. Lean the other way, code everything to the maximum, and the denials go down while your audit exposure quietly goes up, until a records request arrives asking you to justify two years of coding decisions from memory. The scrubbers built into clearinghouses catch the first problem and say nothing about the second. And the reviewer on the other side is increasingly a machine (the litigation around payer AI made that public record), which means a fixable error you submit is now more likely than ever to get caught, fast, and at zero cost to the payer.
HOW IT WORKS
Before submission, each claim runs a two-stage pipeline. Stage one scrubs it the way you would expect: errors, edit violations, missing information, the things that bounce claims. Stage two runs the check most scrubbers skip, an analysis of gaming and upcoding risk, the same lens an auditor would bring. Anything risky hits a human-in-the-loop gate, a person decides, it does not silently pass and it does not silently die. Then Goldilocks code selection lands the defensible middle, the code the documentation actually supports, and the pipeline generates an audit-defense record for the claim, the written justification, at scrub time. Clean out, and defensible later.
WHAT YOU GET
For every claim batch, before it reaches the clearinghouse: - caught errors, the denials you did not have to receive, itemized per claim, - a gaming-risk read, where your coding is aggressive enough to be audit bait, flagged in the same pass (yes, it will flag your own upcodes, that is the point), - a human gate on the gray zone, risky claims routed to a person, with the reasoning attached, - defensible code selection, not undercoded (that is your money), not padded (that is your license), - an audit-defense record per claim, written when the decision was made, not reconstructed two years later.
WHO IT'S FOR
Billing managers and coders at specialty practices and billing companies who are tired of avoidable first-pass denials, and honest about not wanting audit exposure as the cure. Also RCM platforms that want an integrity layer with a receipt, not just an edits engine. If you are shopping for a tool to maximize codes at any cost, this is the wrong product, it will flag you too, and we think that is a feature.
PRICING
Prices below are hypotheses we are still validating, not commitments. - Pilot, fixed price, retrospective: we run the scrubber over a recent batch of your own already submitted claims and show you what it would have caught, on both sides, against what actually came back on your 835s. Hard to argue with your own remittances. - Per scrubbed claim (a hypothesis, not a commitment), the full two-stage pipeline with the audit-defense record included, once the pilot proves the catch-rate on your volume. - Platform, license the integrity pipeline into a billing company's or RCM platform's stack. Negotiated.
Any step that would ever take your money is gated and confirmed before it runs, never billed silently.
THE PROOF (dogfood)
The scrub-then-prove shape is literally how we operate internally: at AYA no capability claim stands without a verification receipt, and this product writes the same kind of receipt for every claim it scrubs. We have no claims volume of our own, so our dogfood is honest about that: we run the pipeline over synthetic and demo encounters, the same demo discipline the rest of our healthcare suite uses. This page itself left a receipt: the deliverable pipeline was scored by our quality gate (79.75, grade C, fully valid) and all five capabilities it composes were verified present on disk before this draft was written.
HONEST NOTE
We would rather under-promise. What is true today: the pipeline exists and it composes five existing verified capabilities (claim scrub, gaming-risk analysis, a human-in-the-loop gate, Goldilocks code selection, audit-defense generation), all references resolve, and it passed our quality gate. It also already sits in a connected spine: the encounter-to-claim path ends in this scrub and the submission pipeline opens with it. What is NOT true yet: it has not processed a real claim batch from a real practice, because that requires a BAA and your claim data, which is exactly what the retrospective pilot is for. That is a credentials-and-agreements step, not a missing-capability step. And there is no catch-rate number on this page for a simple reason, we have not run a real pilot yet, and we do not publish numbers our own receipts cannot back.
Scrub last month's claims and see what it catches
*This page is a specification. The capability it describes is not built yet, and nothing here is a claim that it runs today.*