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Elation’s AI Billing solution also provides claim-scrubber-style feedback on the bill before submission, including support for the following areas:
- insurance eligibility issues
- Quality reporting requirements
- NCCI rules
- missing drug codes
- Clearinghouse validations
- custom payer-specific rules
Scrubbing claims identifies potential rejection or denial issues upfront so you don’t spend time fixing claims later.
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Agent
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Scrubs for…
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Insurance Eligibility
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- Verifies patient has insurance information on file.
- Verifies active primary insurance coverage at the claim level.
- Identifies any potential secondary insurance indicated in the eligibility response.
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NCCI Rules
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- Flags when the units/quantity for a CPT code on a single Date of Service exceeds CMS limits for that code.
- Flags invalid or mutually exclusive CPT code combinations on the same claim and when a modifier is required to bill those CPT Codes together.
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Clearinghouse Rules
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- Verifies patient has an address on file.
- Verifies there are no duplicate service lines.
- Verifies there are no $0 charge lines.
- Verifies diagnosis codes exist on all charge lines.
- Flags if modifier 95 is associated with the wrong place of service.
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The claim scrubber must be enabled by an Admin Level User by following these steps:
| 1 | Click Settings -> Billing. |
| 2 | Go to the AI Billing section and set the Billing Analysis toggle to green (ON). |
To create custom rules for claim scrubbing:.
| 1 | Click Settings -> Billing. |
| 2 | Go to the AI Billing section and click + Add Validation. |
| 3 |
Select the Claim Scrub Agent you would like to create a rule for:
- Payer - Create a rule for specific Payers listed.
- Eligibility - Create a rule based on the patient’s insurance eligibility.
- NCCI validation - Create a rule based on NCCI rules.
- Clearinghouse validation - Create a rule based on Clearinghouse rules.
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Select Payers that are tied to this rule, if applicable.
- You can only select Payers that are in your Insurance Carriers list in the EHR.
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| 5 | Specify the Condition you want the rule to look for. Be as detailed and as specific as you can. |
When using CPT Codes 97110 or 97140, a modifier GP is required. Knowing this, you can create a custom rule to flag any claim that matches these conditions before it gets denied.
To do so:
| 1 | Go to the AI Billing section and click + Add Validation. |
| 2 | Select Clearinghouse validation under Claim Scrub Agent. |
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Put the following instructions in the Condition field:
- Automatically fail if modifier GP is not added to 97110 or 97140
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| 1 | Click + Add Billing Information or Edit Bill to open the bill. |
| 2 |
Trigger the claim scrubber using one of the following workflows:
- Clicking the Generate Codes/Apply Codes button that triggers AI Coding.
- Clicking the Reanalyze with latest changes
 button at the top of the Billing Analysis section of the bill.
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| 3 | Areas with errors will have a red Error label. Review errors by clicking Show Logs. |
| 4 | Adjust what is needed based on the described errors. |
| 5 | Click Reanalyze with latest changes button to verify your adjustments passed claim scrubbing. |
| 6 | Repeat steps 2- 5 until all errors are corrected. |
ℹ️ NOTE You don't need to resolve all errors before signing the visit note or bill — you can sign and come back to make corrections later, as long as the bill remains in the EHR. Any errors associated with a bill can be viewed from the
Billing Home.
Why can’t I see the Billing Analysis section in the bill?
You must enable Billing Analysis Settings in order for the Billing Analysis section to appear in the bill. Follow the Setup instructions above to enable the Setting.
How long does it take for the claim scrubber to detect corrected errors?
The claim scrubber will detect corrected errors once you click the Reanalyze with latest changes button in the Billing Analysis section of the bill.
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