Claims
Claim scrubbing
Deterministic rules catch the boring mistakes before a payer does. Every claim runs through rules-based validation before it can go anywhere. Hard failures stop the claim. Generic AI "checks" are hard to trust because you can't tell why they flagged something. What ships here includes deterministic, repeatable validation rules; hard fails versus acknowledgeable warnings. Used day to day by biller, supervisor roles, with availability marked available. Open the sample screen on the right, then walk the steps below — or book a demo and put your hand on the same flow with synthetic data.
CLM-24-08812 · J. Alvarez · Lakeview Ortho
Scrub results
Lines
What it is
Every claim runs through rules-based validation before it can go anywhere. Hard failures stop the claim. Warnings can be acknowledged by a person, and that acknowledgement is recorded.
The problem it solves
Generic AI "checks" are hard to trust because you can't tell why they flagged something. Billers need to know exactly which rule failed and what to change, every time, in the same way.
Process
How it works, step by step
- 1
Rules run on save
Required fields, code formats, date logic, authorization requirements and payer-specific checks run the moment a claim is saved.
- 2
Errors and warnings are separated
A missing prior authorization can hard-fail the claim. A softer concern shows up as a warning with a plain explanation.
- 3
Optional AI explanation
If a rule result is confusing, the assistant can explain it in plain English. The rule itself doesn't change.
- 4
Acknowledge or fix
Fix the issue, or acknowledge a warning on purpose. Either way, MEDBIX remembers who decided and when.
What's included
Everything below is part of claim scrubbing today.
- Deterministic, repeatable validation rules
- Hard fails versus acknowledgeable warnings
- Prior authorization checks that can block a claim
- Specialty-aware advisory rules
- Plain-English AI explanation of any finding
- Every acknowledgement written to the audit log
The guardrail
The scrubber is rules first. AI can explain a finding, but it can't overrule one.
Where it fits: claim status lifecycle
Claims move through clear states. Lists are honest because status changes come from real actions, not someone remembering to update a cell.
- Person decides
- MEDBIX
- 1
Draft
Person decidesBeing built or corrected.
- 2
Validating / ready
MEDBIXScrub rules have run.
- 3
Pending review
Person decidesWaiting for an approver.
- 4
Approved
Person decidesSigned off by a person.
- 5
Queued
MEDBIXLined up for the clearinghouse.
Audience
Who uses it
These roles work with this feature day to day. Access always follows what your admin assigns.
Works closely with
Deep dive
What Claim Scrubbing means in daily ops.
Practical context for Claim Scrubbing: how teams use it, where it sits in the loop, and what to ask in a demo.
- Tied to how billing work actually splits
- Clear on human vs machine responsibility
- Links into related MEDBIX areas
Practice
Where this shows up on a busy day.
From morning eligibility checks to end-of-day posting, Claim Scrubbing connects to the queues your team already lives in.
- Morning coverage and claim build
- Midday scrub and approval
- Afternoon denials and patient pay
Control
Keep a person on the send button.
Whatever page you're on, MEDBIX keeps AI in a propose role. Approvals, posting and rule activation stay human.
- Named approvals
- Visible AI proposals
- Immutable audit trail
Next
See Claim Scrubbing against your volume
Bring your payer mix and the friction you feel today. We'll map it onto sample data in thirty minutes.
- Sample data only
- Your questions drive the agenda
- Written follow-up after
Common questions
Is the scrubber an AI model?
No. The scrubber is deterministic, so the same claim gives the same result every time. AI is only used to explain results when someone asks.
Can we add our own rules?
Payer intelligence can suggest new scrub rules from patterns it sees, and an admin approves or rejects each one before it takes effect.
What happens if we ignore a warning?
You can acknowledge it and move on. The acknowledgement is logged with your name, so there's no mystery later.
Want to walk MEDBIX against your real claim mix?
Thirty minutes with sample data. We'll follow one claim through the gate, then talk about your payers, practices and where the rework hurts today.
Notes from the billing floor
Occasional, practical writing on denials, A/R and running a billing company. No spam, unsubscribe any time.