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.
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.
Need a Quick Call?
Let's Talk About Business Solutions with Our Team
Related products
Products in the suite that work alongside this one.
More about this product
Standards and code sets
- CPT
- ICD-10
How this works with the rest of the suite
- NANO MCRW
The wizard pushes the coder toward the more specific code as the claim is built; the scrubber verifies what was actually built.
- NANO ECM
Scrubbing and submission belong in the same outbound pass, so a claim is checked and sent rather than checked, queued and forgotten.
- NANO RCM
First-pass acceptance is the revenue cycle metric this gate moves most directly.
- NANO FWA
The scrubber protects the provider from its own errors; payment integrity protects the payer from everyone else.
Frequently asked questions
What is claim scrubbing?
- Checking a claim for the errors payers actually reject on, before it is submitted. The point is timing, not thoroughness: a claim that is wrong at the moment it leaves has already cost the treatment plus the staff time to work out what went wrong and resubmit.
What are the three checks?
- Medical eligibility, which asks whether the patient is actually covered for what is about to be claimed under the policy that is actually in force. Medical necessity, which runs universal code checking, code-pair validation and age and gender appropriateness. And medical coding, which verifies the codes against the record rather than assuming them from it.
Cannot a good verification team do this?
- In small volumes, yes. 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 team that knows CPT thoroughly will still miss pairs, age and gender mismatches and eligibility lapses on the thousandth claim of the week. The machine reads the thousandth claim exactly as carefully as the first.
What changes once 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. That removes the downstream work entirely instead of making it faster, which is why it is worth more than an equivalent improvement anywhere later in the cycle.
Does it work with our existing claim flow?
- It is designed to sit in the outbound path rather than beside it. Paired with the eClaim engine, eligibility, medical necessity and coding are checked in the same pass that submits the claim, so nothing has to be routed out to a separate review step and back.