Solutions / Charge Import and Claim Scrubbing
Charge import and scrubbing
Catch claim errors before your payers do.
BillCycle pulls charges from your EHR as they are signed, checks every line against coding edits and payer rules, and tells your billers what to fix before the claim leaves the building.
- Charges flow in from your existing EHR
- NCCI, modifier and payer rule checks on every line
- AI flags likely denials with the reason and the fix
| CPT | Mod | ICD-10 | Units | Charge |
|---|---|---|---|---|
| 99214 | missing | E11.9 | 1 | $165.00 |
| 93000 | I10 | 1 | $48.00 | |
| 36415 | E11.9 | 1 | $12.00 |
How charges get in
From signed encounter to clean claim, without retyping.
Your providers keep charting in the EHR they already use. BillCycle picks up the billing data from there.
01
Provider signs the encounter
CPT and HCPCS codes, ICD-10 diagnoses, modifiers, units, place of service and rendering provider are captured in your EHR as usual.
02
BillCycle imports the charge
Charges arrive by API, HL7 DFT message or scheduled file feed. No manual re-entry, no spreadsheets passed between teams.
03
Every line is scrubbed
BillCycle runs coding edits, payer-specific rules and a denial risk check on each charge line and on the claim as a whole.
04
Billers fix what is flagged
Clean claims move straight to the submission queue. Flagged claims go to a work queue with the issue and a suggested correction.
What gets checked
The edits that cause most front-end rejections and denials.
Scrubbing covers coding rules, payer rules and basic data quality, so problems surface while they are still cheap to fix.
- NCCI procedure-to-procedure edits
- Medically Unlikely Edits (MUE) on units
- Missing or conflicting modifiers (25, 59, XS, XU, 26, TC)
- Diagnosis to procedure linkage and code specificity
- Invalid or deleted CPT, HCPCS and ICD-10 codes
- Place of service and provider credential mismatches
- Payer-specific rules and coverage policies
- Missing subscriber ID, NPI, taxonomy or referring provider
- Duplicate charges for the same patient, date and code
- Timely filing window for each payer
AI denial prediction
Know which claims will be denied before you send them.
Rule checks catch known errors. BillCycle’s AI goes further: it looks at patterns in your past denials and remittances and scores each claim for denial risk before submission. When a claim looks risky, it tells you why and what usually fixes it.
A reason, not just a score
Example: “Likely CARC 4 denial. Procedure code is inconsistent with modifier. Consider modifier 59 or XS if the service was distinct.”
Learns from your payers
Predictions reflect how your payers actually adjudicate, based on your own 835 remittance history.
Billers decide
AI suggests the fix. Your biller accepts, edits or overrides it, and every change is logged.
Payer rules
One rule set per payer, maintained in one place.
Medicare, Medicaid and each commercial payer handle modifiers, bundling and documentation differently. BillCycle keeps payer rules alongside standard coding edits, and lets your team add custom rules for the quirks only they know about.
Custom rules without code
Example: “For this payer, require modifier GT or 95 on telehealth visits.” Set it once and every claim is checked.
Edit library updates
NCCI and code set updates are applied on [update cadence to confirm], so your checks keep pace with quarterly changes.
Rule hit reporting
See which rules fire most often by provider and location, and fix the root cause upstream in documentation.
| Claim | Payer | Status | Age | Amount | Next |
|---|---|---|---|---|---|
| #48213 | BCBS PPO | Rejected | 2d | $225 | Fix modifier |
| #48207 | Aetna | No response | 84d | $3,615 | Call payer |
| #48190 | Medicare | In process | 12d | $860 | Wait |
| #48172 | UHC | Denied CO-16 | 21d | $1,140 | Add info |
| #48165 | Cigna | Paid | 18d | $410 | Done |
Why it matters
A claim fixed before submission costs far less than a denial.
Every rejected or denied claim means rework, resubmission and days added to your AR. Scrubbing moves that work to the front of the cycle.
Fewer clearinghouse rejections
Missing IDs, invalid codes and formatting errors are caught before the 837 is built, not after the 277CA comes back.
Fewer payer denials
Bundling, modifier and medical necessity issues are flagged while the chart is fresh and the provider can still clarify.
Faster first pass
Clean claims go out the same day charges are signed, instead of waiting in a batch for manual review.
FAQ
Charge import and scrubbing questions
Do we have to change how providers enter charges?
No. Providers keep coding and signing encounters in your current EHR. BillCycle reads the charge data from there.
Which EHRs can send charges to BillCycle?
Any system that can share charges by API, HL7 DFT message or file export. Current confirmed connections include [Confirmed EHR]. We confirm your setup during the demo.
Does BillCycle code the encounter for us?
No. BillCycle checks the codes your team assigns. It flags errors and suggests fixes, but coding decisions stay with your coders and providers.
How current are the NCCI and code set edits?
Edit libraries are updated on [update cadence to confirm], including the quarterly NCCI releases and annual CPT and ICD-10 updates.
What happens when the AI flags a claim?
The claim moves to a work queue with the predicted denial reason and a suggested fix. A biller reviews it and decides whether to change, hold or send it.
See your own claims run through the scrubber.
Bring a sample of recent claims and denials. We will show you what BillCycle would have flagged before submission.