ClaimScrub from Zebu Compliance Solutions is a full-service scrubbing solution to assist in pre-submission claim validation. Adding the Zebu Claim Scrub tool to your account will automate the claim review process-- detecting and flagging errors based on a library of payer-compliant edits, and reducing the number of claims sent to medical insurers that are denied or rejected. It is essentially an automated pre-submission claim audit tool.
Where is Zebu in DrChrono?
Zebu lives at the claim level, meaning each claim has its own Zebu section in the Billing Details window (pictured below). If the Zebu section of your claim is missing, then Zebu has not been turned on for your account. Contact your account manager to have this turned on.
How do I send a claim through Zebu scrub?
Aside from having Zebu turned on for your account, there are two requirements to push the claim through the scrub initially.
Firstly, the patient has to have insurance information in the Drchrono system. This can be entered by going to the patient’s profile > Demographics tab > Insurance (pictured below).
Secondly, the claim needs to be moved to the Ready to Bill billing status, then click Verify & Save to trigger the claim for a Zebu scrub. The screen will automatically refresh and scrub the claim.
If there isn’t insurance information or the claim isn’t in the correct status, the claim will not be scrubbed. Below is a screenshot of a claim that hasn’t been scrubbed yet.
Notice that there are two scrub levels, Level One and Level Two.
- Level One (AKA Pre Scrubbing Response) is a basic scrub that checks for claim completion within the DrChrono system
- Level Two (AKA Claim Edit Response) scrubs are run against Zebu’s library of payer-compliant edits such as medical necessity, procedure validation, and bundling logic (to name a few).
During the Scrub
Once the claim is flipped to Ready to Bill + Verify & Save, the claim is sent through the scrub.
If the claim has a Level One error, the details of this error will fall under the Pre-Scrubbing Response section and will be moved into the Scrubbing Error billing status.
In the example below, the scrub identified that there was no charge associated with the CPT code. There are two ways to resolve a scrub error:
- Resolving the issue
- Resolving the issue requires someone to make the suggested changes (in this case, adding a price to the CPT code). Once a change has been made, click Verify & Save to send the claim through the scrub again.
- Overriding the Warning:
- There are some cases where the Level One error is not relevant to this claim or does not apply. If you are sure that the error does not apply, you can click the orange Override Warning button to ignore the error. Then click Verify & Save to send the claim through the scrub again.
After the claim passes Level One (either by correct initial submission, override, or resolution), the claim will then go through the Level Two scrub process. If the claim does not pass this level, the claim will be moved to billing status, Scrubbing Error.
Below is an example of a claim that has passed Level One but has Level Two errors.
As with Level One errors, Level Two errors can be 1) Resolved or 2) Overridden. The error reason will be detailed under the Claim Edit Response section.
The Click here link will open a pop-up window that goes into more detail about the error.
To push past Level Two errors, you can either 1) Resolve the error, or 2) Override the Error using the red Override Error buttons. When the error is overridden, it will look like the image below.
Let’s say that the claim has passed both scrub levels and Zebu has not detected any errors. Below is an example of a claim that has passed both levels.
As soon as a claim passes through Level Two, the claim will automatically be flipped to Bill to Insurance, meaning it will be submitted to the clearinghouse/payer.
Practices and billers can track all Zebu edits, errors, overrides, and status changes in the billing log of each claim. Below is an example of a billing log. Any Zebu changes that are triggered by a person (manually changing the billing status, overriding errors, resolving errors) will have a User associated. Any automatic changes will not have a User stamp but will have a time stamp. (see example below)