Claim Scrubber Lite
Catch the denials you can see coming. Run one claim through the standard Medicare edits — billable diagnoses, MUE unit caps and NCCI bundling — before it goes out the door.
Most denials are visible before the claim ever leaves your system. This free pre-submission check runs the standard edits against one claim: Are the diagnosis codes billable? Do any procedure lines exceed Medicare's Medically Unlikely Edit (MUE) unit caps? Do any two procedures bundle under NCCI? It is the same first pass a billing team runs before submission — free, instant, and nothing you type leaves your browser.
Scrub a claim
What this check covers — and what it does not
- Diagnosis billability: every ICD-10 code is checked against the FY 2026 billable list; header codes are flagged.
- MUE unit caps: each procedure's units are compared with the Medicare MUE value for practitioner services, with the adjudication indicator (MAI) that decides whether the cap can ever be exceeded.
- NCCI bundling: every pair of procedure lines is checked against the active 2026 Q4 Procedure-to-Procedure edits, in both directions.
- Code status: lines whose fee-schedule status is not "Active" are flagged for a second look.
Important: this is a pre-submission check, not a guarantee of payment. It does not verify eligibility, authorisation, medical necessity, LCD/NCD policy, timely filing or payer-specific rules. A claim that passes can still deny — and our billing team reviews far more than any single tool. When a pattern below keeps repeating in your own claims, that is usually the sign the revenue cycle needs a full review.
Data: CMS CY 2026 Physician Fee Schedule (RVU26D), FY 2026 ICD-10-CM, NCCI PTP practitioner edits and Practitioner Services MUEs effective October 1, 2026 — all official public files.
Frequently asked questions
What does this claim scrubber check?
Four things: that every diagnosis code is on the FY 2026 billable ICD-10-CM list, that no procedure line exceeds its Medicare Medically Unlikely Edit (MUE) unit cap, that no two procedures on the claim are bundled by an active NCCI Procedure-to-Procedure edit, and that every procedure code has an Active status in the CY 2026 fee schedule.
If my claim passes, will it definitely be paid?
No — and any tool that promises that is misleading you. This scrubber covers the code-level edits Medicare publishes. It cannot check eligibility, prior authorisation, medical necessity, coverage policies (LCD/NCD), timely filing or a specific commercial payer's proprietary edits. Passing removes the most common preventable denials; it does not guarantee payment.
What is an MUE and what does the MAI mean?
A Medically Unlikely Edit is the maximum number of units of a service Medicare considers plausible for one patient on one date of service. The MUE Adjudication Indicator decides what happens above the cap: MAI 1 is a claim-line edit (units can sometimes be split across lines with a modifier), MAI 2 is an absolute policy cap that no modifier can override, and MAI 3 is a clinical cap that documentation and an appeal can sometimes overcome.