NANO CSS

NANO Claim Scrubber Enterprise Solution

A rejection is decided before the claim is submitted

By the time a rejection comes back, the money has already been spent twice: once treating the patient, and again on the staff time it takes to work out what went wrong and resubmit. The claim was wrong at the moment it left. NANO CSS is the gate it passes through on the way out.

Every claim is checked for the errors payers actually reject on — ineligible cover, services a payer will not accept as necessary, and codes that do not survive validation — while the claim is still yours to fix.

Why this is not a job for people

Manual scrubbing is possible, and in small volumes it even works. It fails for an unremarkable reason: it is exhaustive, repetitive checking under time pressure, which is the exact task human attention is worst at and software is best at.

A verification team that knows CPT thoroughly will still miss pairs, age and gender mismatches and eligibility lapses — not through incompetence, but because they are reading the thousandth claim of the week. The machine reads the thousandth claim exactly as carefully as the first.

What changes when the gate is there

Fewer rejections, because the errors payers reject on are caught while the claim can still be corrected rather than after it has been refused.

Fewer rejections, because the errors payers reject on are caught while the claim can still be corrected rather than after it has been refused.

Fewer rejections, because the errors payers reject on are caught while the claim can still be corrected rather than after it has been refused.

Every Medical Claim goes through a 3 step scrubbing check before it is approved. They are as below:

Medical Eligibility Check

Eligibility is checked before the service is billed, not after: whether the patient is actually covered for what is about to be claimed, under the policy that is actually in force.

Medical Necessity Check

Universal code checking, code-pair validation, and age and gender appropriateness — the mechanical contradictions that are invisible to a busy reader and obvious to a payer.

Medical Coding Check

Coding is verified against the record rather than assumed from it, so the diagnoses, procedures and services on the claim are the ones the documentation will support if anyone asks.