ClaimScrubTM 

Medical Claims Done Right.

Medical Necessity

Utilize coverage requirements for Medicare, Medicaid, and dozens of private payers

Correct Coding

Validate codes, modifiers, CCI, quantities, bundling, and more

Contextual Feedback

Know what the problem is, how to fix it, and a link to the source

Support

100% originally sourced data curated by our nationally-certified content team

How Zebu Helps You

  • Inpatient, Outpatient, Specialty Claim Support
  • Facilitate Prompt Payments
  • Reduce Staff Time with Clear Messaging and Context-Based Source Links for Additional Information
  • DashBoard Provides Insight into Trends, Benchmarks, and Opportunities
  • Average 10,000 Changes per Week to Coding and Coverage Rules – We’re on Top of Them Every Day with a nationally certified content team that curates every change
  • Tested constantly by thousands of client sites across every specialty

ClaimScrub does the Impossible, so you can do the Important

  • Custom Edit Engine for the Last Mile
  • Establish Custom Edits or Modified Rules for Specific Providers or Provider Types.
  • Custom Edits are Fully Integrated, Fully Documented, and Fully Transparent
  • Most Nuanced and Complete Rule Engine Available
  • Easy to Use

But wait there’s more!

Optional extension modules include:

  • Historical Edit Module tracks care, coding and coverage across time, providers, and multiple claims: identify issues with bundling, 3-day rule, post-op periods, related care episodes, duplicate billing, split claims
  • Medicare reference pricing module
  • Payment Calculation module for RVUs and Fee Schedules
  • Patient Pre-Service Share of Cost Estimations module

Why Buy 16,229 Puzzle Pieces and ask your Staff to Build a Baby Zebu Every Day?

Claims and revenue cycle are mission critical. Let a fully grown and battle-tested Zebu give you everything, pre-assembled, and ready to go. Founded, operated, and supported 100% by  in-house staff in Ohio. We’ve got your back.

There’s a bazillion medical codes, Combinations, and rules to keep track of, but ClaimScrub keeps it all straight.

Full-service scrubbing solution

We’ve developed systems to help manage the revenue cycle so that we can tell you with incredibly high confidence, that for this patient, on this day, with this coverage, this provider, this service, and this condition, you’re good to go!   

Content Libraries

Medicare Administrative Contractors (MACs)
Ambulance Services HHH MAC Jurisdiction 15 MAC 5
DME MAC Jurisdiction A Jurisdiction E MAC 6
DME MAC Jurisdiction B Jurisdiction F MAC 8
DME MAC Jurisdiction C Jurisdiction H MAC 10
DME MAC Jurisdiction D Jurisdiction K MAC 11
HHH MAC Jurisdiction 6+K Jurisdiction L MAC 15
HHH MAC Jurisdiction M Jurisdiction N
State Medicaids
Alaska Medicaid Iowa Medicaid New Mexico Medicaid
Arkansas Medicaid Maine Medicaid New York Medicaid
California MediCal Minnesota Medicaid Oklahoma Medicaid
Colorado Medicaid Mississippi Medicaid Texas Medicaid
Florida Medicaid Montana Medicaid Virginia Medicaid
Illinois Medicaid Nebraska Medicaid Wyoming Medicaid
Indiana Medicaid

PRIVATE PAYERS
Aetna BCBS Ohio (Anthem)
Anthem BCBS Oklahoma (HCSC)
BCBS Alabama BCBS South Carolina
BCBS Arizona BCBS South Dakota (Wellmark)
BCBS Arkansas BCBS Tennessee
BCBS California (Anthem) BCBS Texas (HCSC)
BCBS Colorado (Anthem) BCBS Virginia (Anthem)
BCBS Connecticut (Anthem) BCBS Virginia (CareFirst)
BCBS District of Columbia (CareFirst) BCBS Wisconsin (Anthem)
BCBS Florida Cigna
BCBS Georgia (Anthem) ConnectiCare
BCBS Illinois (HCSC) Coventry Health Iowa
BCBS Indiana (Anthem) Coventry Health Nebraska
BCBS Iowa (Wellmark) Excellus (New York)
BCBS Kentucky (Anthem) Health Net
BCBS Maine (Anthem) Highmark
BCBS Maryland (CareFirst) Harvard Pilgrim
BCBS Massachusetts Health Partners
BCBS Minnesota Humana
BCBS Mississippi Medica
BCBS Missouri (Anthem) Premera (FKA BCBS AK WA)
BCBS Montana (HCSC) QualChoice
BCBS Nebraska Tufts Health Plan
BCBS Nevada (Anthem) UCare
BCBS New Hampshire (Anthem) United Healthcare
BCBS New Mexico (HCSC) UHC Oxford
BCBS New York (Anthem) Wellcare
BCBS North Dakota Wellmark

 Standard ClaimScrub Edit Modules

ClaimScrub Edit Summary
Module: Diagnosis code validation  Module: Modifier combination validation
Module: Procedure code validation Module: Revenue code validation
Module: Medical necessity validation Module: DRG validation
Module: Diagnosis usage validation Module: National Drug Code validation
Module: Procedure usage validation Module: Revenue code/procedure validation
Module: Modifier validation Module: Medicare Code Editor validation
Module: Modifier-procedure validation Module: TAR validation
Module: CCI validation Module: Patient history validation
Module: Place of service validation Module: DRG grouper
Module: Place of service-procedure validation Module: APC grouper
Module: MUE validation Module: Patient Cost Estimation
Module: National Provider Identifier validation Module: Reimbursement Calculation

Systematic review from your smallest to largest services for inpatient, outpatient and specialty claims, 100% transparent and customizable. Find out how Zebu can help you!