Claim Scrubbing
Validate every claim before submission
With Claim Scrubbing,
The Fleet Owner can
validate claims before submission
so they can
catch errors before they become denials
— resulting in 97%+ first-pass acceptance.
The Problem
The Core Problem
Preventable claim denials are the single biggest avoidable revenue leak in NEMT operations.
The Scenario
A biller submits 120 trips to Modivcare at month-end. 14 come back denied 3 weeks later.
Why It's Urgent
Of the 14 denials, 6 are missing patient signatures, 4 have GPS coordinates that do not match the billed address, and 4 are duplicates of previously submitted trips.
Without MediRoutes
The biller spends 2 days correcting and resubmitting. Some corrections require tracking down drivers for signatures that may no longer be retrievable. 3 trips are written off entirely.
With MediRoutes
ClaimLock™ catches all 14 issues before submission. The biller fixes the 10 correctable issues in 30 minutes. The 4 that cannot be corrected are documented and managed, not discovered 45 days later.
Who This Helps
The Fleet Owner
claim denials discovered 30 to 60 days after the trip was performed are nearly impossible to fix and represent pure revenue loss. Frustrated by a problem that should have been caught the day it happened.
The Broker Compliance Officer
manual review of incomplete trip data bottlenecks payment for everyone. ClaimLocku2122 means providers arrive clean, reducing the compliance officer's workload and speeding up payment.
How It Works
Each step shows what happens when things go right — and what MediRoutes does when they don't.
Start / End
Process Step
Decision Point
Common Questions
Patient signature present if required, driver signature present if required, GPS coordinates at pickup and dropoff, timestamps for all required events, mileage within expected range, and no duplicate claim for the same trip.
Validation rules are inherited from the Funding Source Billing configuration. What you have told MediRoutes a payer requires is what ClaimLocku2122 enforces.
ClaimLocku2122 detects if a claim for the same trip ID, patient, date, and payer has already been submitted, preventing accidental double billing.
Override a ClaimLocku2122 flag with a documented reason, creating an audit note. Available when the deficiency is expected and documented, for example when a patient was unconscious and could not sign.
ClaimLocku2122 runs before both EDI file generation and API-based broker submission, regardless of the claim format.
The billing module includes a ClaimLocku2122 error summary showing the most common failure reasons over any date range, useful for identifying training gaps or process issues.