eClinicalWorks claim scrubbing checks each claim for errors before it reaches the clearinghouse and payer. So why do some claims still get rejected when the data looks complete? In most cases, the scrubber caught what it was built to catch, but a payer rule, an authorization, or the documentation failed later.
In this guide, we explain how eClinicalWorks claim scrubbing works, what it checks, why claims can fail after a clean scrub, and how to raise your clean-claim rate.
What Is eClinicalWorks Claim Scrubbing?
Claim scrubbing reviews a claim for preventable errors before electronic submission. According to eClinicalWorks, its partnered clearinghouses provide real-time claim scrubbing inside eClinicalWorks Practice Management. In addition, they offer eligibility checks, claim status updates, clearinghouse reports, and electronic remittance advice.
Depending on your setup, the scrubber can review patient and insurance data, provider details, CPT and HCPCS codes, diagnoses, modifiers, and payer-specific rules. Ultimately, the goal is simple: fix problems before they become rejections.
How Does the eClinicalWorks Claim Scrubbing Process Work?
Quick visual guide
Where a claim can fail
1. Scrub
eClinicalWorks and the clearinghouse check data, codes, and modifiers before submission.
2. Clearinghouse
Format and payer-level front-end edits can still reject the claim.
3. Payer adjudication
Coverage, authorization, and medical necessity rules decide payment.
A clean scrub lowers rejections, but it never guarantees payment.
Step 1: Patient and insurance data
First, the claim needs accurate demographics, member ID, subscriber details, and the correct payer. Notably, eligibility checks confirm coverage, while the scrubber checks the claim itself. You need both. Our article on eCW eligibility verification failures covers the most common front-end gaps.
Step 2: Provider data
Next, the scrubber validates the billing and rendering provider, NPI, tax ID, specialty, and location. For example, eClinicalWorks has described a client whose scrubbing setup used 475 rules to validate tax IDs, provider overrides, and CPT codes across payers, states, and specialties.
Step 3: Codes and modifiers
Then, the claim faces coding edits. These can flag invalid codes, missing diagnoses, and code pairs that should not appear together. Many of these checks mirror the CMS NCCI edits. However, add modifiers only when the documentation supports them, never just to bypass an edit.
Step 4: Payer-specific rules
Finally, custom rules handle what each payer expects. As a result, a practice can build edits by payer, provider, specialty, CPT code, tax ID, or location.
What Does an eClinicalWorks Claim Scrubber Check?
The exact edits depend on your configuration, clearinghouse, and payers. Still, most setups cover these areas:
| Claim area | Typical checks |
|---|---|
| Patient | Demographics, member ID, subscriber details |
| Insurance | Payer selection and eligibility |
| Provider | NPI, tax ID, rendering provider |
| Procedures and diagnoses | Valid CPT, HCPCS, and ICD-10 codes |
| Modifiers | Missing or invalid combinations |
| Claim data | Required fields and formatting |
| Payer rules | Custom payer and specialty edits |
Scrubbing vs. Payer Adjudication
This distinction matters most. Scrubbing happens before or around submission and looks for preventable data and coding problems. In contrast, adjudication happens after the payer receives the claim and applies coverage and payment policies.
Similarly, a rejection and a denial are different. A rejection means the claim failed a processing edit, so you correct and resubmit it. A denial means the payer processed the claim but refused payment, so you may need a correction, an appeal, or a records review. For help reading clearinghouse messages, see our guide to clearinghouse rejection codes.
Why Claims Fail After eClinicalWorks Claim Scrubbing
Scrubbing reduces errors, but it cannot remove every risk. For instance, the payer may run edits the scrubber does not know about. Also, data can be complete but wrong, such as a mistyped member ID in the right field. Coverage can change between visits, too. In addition, a missing authorization or weak documentation can sink a technically clean claim.
How to Improve eClinicalWorks Claim Scrubbing Results
Keep front-end data current
Accurate registration comes first. So, confirm demographics, member and group numbers, subscriber details, the payer, and coverage dates at every visit.
Keep provider setup accurate
Likewise, update provider records whenever a provider joins, a location opens, or enrollment changes. Then, review the related claim setup.
Analyze recurring rejections
Fixing the same rejection again and again wastes time. Instead, track rejections by payer, provider, code, modifier, reason, and location. If one payer keeps rejecting one provider for one issue, the root cause is likely setup or workflow.
Add rules for high-volume errors
When one error repeats, add a scrubber rule to catch it earlier. However, avoid rules that create extra work without solving a real problem.
Track claims after the scrub
Lastly, follow each claim from creation to payment. That way, you can see whether problems start with data, clearinghouse edits, or payer processing. Tracking your first-pass claim acceptance rate shows whether your changes work.
Get Expert eClinicalWorks Billing Support
In short, eClinicalWorks claim scrubbing is a strong checkpoint, not a payment guarantee. The best results come from accurate front-end data, clean coding, smart payer rules, and steady rejection analysis.
Dr Biller RCM helps practices get more from eCW. Explore our eClinicalWorks medical billing services, see our full eClinicalWorks RCM services, or request a free RCM audit to find where your claims fail.
FAQs
What is eClinicalWorks claim scrubbing?
It is the process of checking claims for errors before electronic submission. eClinicalWorks’ partnered clearinghouses provide real-time scrubbing inside its Practice Management system.
Does claim scrubbing prevent all denials?
No. It reduces preventable errors. However, payers can still deny claims for coverage, authorization, medical necessity, or documentation reasons.
Why is a claim rejected after it passes the scrub?
The clearinghouse or payer may apply more edits later. Also, the data may be complete but incorrect.
How can practices reduce rejections in eClinicalWorks?
Focus on accurate registration, eligibility checks, provider data, correct coding, payer rules, rejection analysis, and post-submission tracking.
