Featured Case Study
claimstaker
Claim scrubbing software that stops denials.
ClaimStaker validates professional and institutional claims against payer, coding, coverage, medical necessity, and specialty logic before submission — catch risk before the payer does.
SOC 2 Type II · HIPAA Compliant · HITRUST Certified
Logic for every specialty
- 40 years of expertise
- 330M+ annual Transactions
- 3 week content updates
The problem
A claim can pass your checks and still fail at the payer.
Standard edits catch obvious coding problems. They don't always account for the payer-specific logic that determines payment — coverage, medical necessity, bundling, LCD/NCDs, and MUEs.
By the time that gap shows up, the claim is already downstream. Payment is delayed, staff have to work it again, and the organization absorbs the cost of a problem that could have been caught before submission.
How CLaimstaker works
Check beyond the basics.
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01
Get the claim in
Professional and institutional claims come in through XML, API, batch, or SFTP — without changing where your team works.
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02
Find what could stop payment
Claims run through the relevant validation edits, showing exactly what fired. Know what needs attention instead of hunting through a dirty claim.
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03
Work what matters
Clean claims move on. Exceptions come back with something your team can actually fix.
Key features & benefits
The edits behind better-paid claims.
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Deep edit coverage
Payer, coding, specialty, medical-necessity, and proprietary logic beyond standard code sets.
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Professional + institutional claims
One claim-scrubbing layer across both claim types, built for different billing environments.
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Continuously maintained
CMS, payer, regulatory, LCD/NCD, CCI, coding, and medical-necessity content stays current.
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All specialties covered
Start with proven reimbursement logic, then tailor it to your revenue cycle.
Who it's for
Built for the teams who own the claim.
Your clearinghouse catches the obvious. ClaimStaker adds the payer, clinical, and specialty context that can still change whether the claim gets paid.
Payer requirements change. Specialty guidance evolves. Work from maintained content instead of hunting through policies claim by claim.
Know exactly what fired, why it matters, and what needs to change — without digging through vague edits or working the same claim twice.
Give customers deeper clinical claim editing without building and maintaining the content yourself. Then add logic to the workflow they already use.
Customer results
Real numbers. Measured outcomes.
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Large Health System
Physician billing
4days out of A/R
Went from thousands of daily edits to 150–200 per day, with a 4% increase in clean claim rate.
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PM/EHR Partner
Orthopedics
$37Min errors caught
17 different provider fee schedules. 33% of $112M in claims contained errors.
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Medical Billing
Hospital-based pathology
$331Mpotential savings found
17% of $1.9B claims had errors. Stopped repeated CCI edits on pathology claims.
Common questions
Answered clearly, no sales pitch.
What is claim scrubbing software?
Claim scrubbing software checks completed claims before submission for coding, clinical, coverage, medical-necessity, and payer-specific risk — giving your team a chance to fix the claim before it reaches the payer.
What does a medical claim scrubber check?
ClaimStaker checks coding combinations, modifiers, bundling, medical necessity, coverage, payer requirements, and specialty-specific logic. What it checks depends on the content and configuration.
How is ClaimStaker different from a clearinghouse scrubber?
ClaimStaker can work with the clearinghouse — or inside it — adding deeper logic to the claim review.
Does ClaimStaker support professional and institutional claims?
Yes. Both — across ambulatory, acute, and post-acute billing environments.
How often is ClaimStaker content updated?
Every three weeks. Clinical and regulatory content stays current without putting the research and maintenance burdenon your team.
Can we add our own claim-editing logic?
Yes. Configure existing logic or add your own for specific payers, specialties, contracts, and billing requirements.
Does ClaimStaker replace our EHR, practice management system, or clearinghouse?
Protect more of what you bill.
Catch payer-specific, clinical, and specialty risk before it comes back as rework.
Book a demo40+ years proven in production · Specialty depth from day one