Claim scrubbing
Starts whenA claim is ready to bill
Runs the edits for the payer and specialty, and runs them again whenever the claim or an answer changes.
Claims management
Clean claims out. Paid claims back.
Fewer rejections, fewer denials, and no claim left sitting with a payer until the filing limit passes.
- Every claim scrubbed before it bills
- 999 and 277CA rejections fixed and resent
- Claim status chased, timely filing protected
How it runs
From ready to bill to paid.
- 01
Ready to bill
worklist picks up the claim the moment your billing system marks it ready.
- 02
Scrubbed for this payer
Eligibility, authorization, documents, codes and modifiers, NCCI and MUE edits, NPIs, place of service and coordination of benefits.
- 03
Fixed or held
Fixed from the source record when it can be, sent to a coder for judgment calls, or held with a request when only the practice can help.
- 04
Sent and acknowledged
Through your billing system and clearinghouse, with the 999 and 277CA watched for every claim.
- 05
Rejections fixed
Classified by status code, corrected and resent, after a 276 confirms it won't be a duplicate.
- 06
Followed until paid
276/277 status checks on each payer's clock, then the portal, then a prepared call.
Every automation
What claims management includes
Each one runs on its own, inside the systems you already use, and only asks a person when your rules say so.
Coding review
Starts whenA line doesn't fit the diagnosis or the payer
Flags it for a coder with the rule that fired and the evidence from the note. Never upcodes.
Rejection fix and resend
Starts whenA 999 or 277CA rejection arrives
Member ID, name and date of birth, NPI and taxonomy, payer ID and invalid codes fixed, then resent within one business day.
Acknowledgement watch
Starts whenA claim is sent
Waits for the 999 and 277CA and raises a task when one never comes, so no claim disappears in transit.
Claim status follow-up
Starts whenA claim passes the payer's usual days
Looks for a missed remittance first, then runs 276/277, the payer portal and a prepared call. Every contact is logged with its reference number.
Timely filing protection
Starts whenA held claim nears its filing limit
Raises priority at 30 days, chases open requests at 14 and asks to send at 7. Before a first send, nothing goes out without a yes.
Never received resubmission
Starts whenThe payer has no record of the claim
Resends with proof of timely filing and confirms it was accepted.
Payer records requests
Starts whenA payer asks for records by 277 or letter
Reads what's asked, gathers only that, requests what's missing from the practice and sends the packet before the deadline.
Where your team steps in
Your billers work the exceptions, not the queue.
Clean claims go out on their own. A person only sees a claim when it needs a decision, with everything needed to make it.
- Coding questionsFlagged lines go to a coder with the note and the rule that fired.
- Rejections automation can't fixThe same rejection twice goes to a person with the reason and the fields to change.
- Payer callsPrepared with the claim's history and grouped by payer, up to the payer's per-call limit.
FAQ
Questions, answered
Does worklist submit claims itself?
Claims go out through your billing system and clearinghouse, as they do today. worklist decides when a claim is ready, fixes it and follows it until it's paid.
Which edits does claim scrubbing run?
Eligibility, authorization, required documents, codes and modifiers, NCCI and MUE, NPIs, place of service, duplicates, coordination of benefits and each payer's own rules, by payer and specialty.
How does it avoid sending duplicates?
Before resending an older claim it checks status with a 276. If the payer already has it, nothing is sent.
What happens near a timely filing limit?
A ladder: higher priority at 30 days, calls on open requests at 14, a request to send at 7. After the limit, worklist looks for exceptions before it proposes a write-off.
Early access
Run your revenue cycle as workflows.
We are working with a small group of billing and operations teams to shape worklist. Tell us where your work gets stuck, and we'll show you how it would run.
Request early accessor write to [email protected]
One platform, every role