837 Scrubbing Rules
Pre-adjudication validation of 837 claims. Up to 15 criteria, joined by AND.
| Rule ID | Rule Name | Category | Status | Trigger | Criteria | Actions |
|---|---|---|---|---|---|---|
| R000000000001 | Place of Service Validation | Claim Data | ACTIVE | Date of Service (2025-01-01 → 2027-12-31) | Place Of Service Equals "11" | |
| R000000000002 | Carrier Category | Carrier | ACTIVE | Date of Service (2025-01-01 → 2027-12-31) | Carrier Category Equals "Commercial" ANDBilling Group Equals "BILL2" | |
| R000000000003 | Medicare NPI Required | Provider | ACTIVE | Date of Service (2025-01-01 → 2027-12-31) | Line Of Business Equals "Medicare" ANDBilling Provider NPI Is not blank | |
| R000000000004 | Facility Required | Facility | ACTIVE | Date of Service (2025-01-01 → 2027-12-31) | Facility Is not blank | |
| R000000000005 | Billing Units Check | Charge | ACTIVE | Date of Service (2025-01-01 → 2027-12-31) | Billing Units Does not equal "0" | |
| R000000000006 | Diagnosis Code Required | Claim Data | ACTIVE | Date of Service (2025-01-01 → 2027-12-31) | Diagnosis Code Is not blank | |
| R000000000007 | Procedure Code Format | Charge | ACTIVE | Date of Service (2025-01-01 → 2027-12-31) | Procedure Code Does not begin with "X" | |
| R000000000008 | Medicaid Secondary Required | Carrier | ACTIVE | Date of Service (2025-01-01 → 2027-12-31) | Line Of Business Equals "Medicaid" ANDSecondary Payer Is not blank |