Stop claims from getting rejected before they ever reach the payer. V1RCM performs multi-tiered automated scrubbing and human review to ensure a 99.2% first-pass clean rate.
When claims are batched and sent without pre-submission scrubbing, clearinghouses throw them back days later. Each throwback delays payment cycles by 2 to 4 weeks.
V1RCM subjects every claim file to our three-tier scrubbing protocol: validating demographic integrity, checking National Correct Coding Initiative (NCCI) edit rules, and evaluating payer-specific custom policies before generating the 837P or 837I EDI batch.
Validates NPI numbers, taxonomy codes, patient identifiers, and active clearinghouse payer IDs.
Checks mutually exclusive procedure pairs, unbundling triggers, and required CPT modifiers (-25, -59).
Applies specific guidelines for regional Medicare MACs, state Medicaid, BCBS, and commercial insurers.