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Resolving scrub errors

Henry
Updated

When you submit an electronic claim in SimplePractice, our system automatically checks for common issues that could cause an automatic rejection on the payer’s end. If any errors are detected, the claim receives a Scrub error and isn’t submitted to the payer.

Scrubbed claims don't incur a $0.25 fee, as they weren’t successfully sent to the payer. Once you’ve identified and corrected the error, you can delete the claim and recreate it without an additional processing fee.

In this guide, we’ll review some common scrub errors and how to resolve them:

NPI required errors

A scrub error stating that the billing provider NPI and/or rendering provider NPI is required indicates that at least one NPI is missing on the claim. Insurance payers require both NPIs on claims in box 24j and box 33a.

The rendering provider NPI is an Individual (Type 1) NPI, while the billing provider NPI can be an Individual NPI or an Organization (Type 2) NPI.

To have your rendering provider NPI populate claims:

  1. Navigate to Settings > Profile > Clinical info
  2. Click Edit next to Clinician details
  3. Enter your individual NPI

To have your billing provider NPI populate claims:

  1. Navigate to Settings > Billing and Services > Insurance billing
  2. Click Edit next to your default Billing provider info

  1. Select Individual if your billing provider NPI is your Type 1 NPI, or Organization if your billing provider NPI is your Type 2 NPI
  2. Enter your NPI
  3. Confirm the billing provider name, taxonomy code, and address listed are correct
  4. Click Save profile

After updating your NPI information, delete the scrubbed claim and create a new claim for the client’s appointment(s). The rendering provider NPI will populate in box 24j, and the billing provider NPI will populate in box 33a. If your billing provider NPI is your Type 1 NPI, it’s expected that the same NPI will be listed in both boxes.

For more details on how NPIs populate to claims, see Filing claims with both your organization NPI and individual NPI.

NPI not enrolled

Certain insurance payers require an accepted claim filing enrollment before you can file claims electronically. If you receive a scrub error stating that your NPI should be enrolled before you can start submitting claims, your claim filing enrollment with the payer hasn’t been submitted or accepted.

Note: See Submitting enrollments to file claims and receive Payment Reports for more information on submitting a claim filing enrollment.

The billing provider NPI on claims and enrollments should match the billing provider NPI that the payer has on file. If the NPI listed on the enrollment is different from the NPI on claims, you can:

  1. Delete the scrubbed claim
  2. Navigate to Settings > Billing and Services > Insurance billing
  3. Click Edit next to your default Billing provider info
  4. Update the NPI to match the NPI that the enrollment is accepted under
  5. Confirm that all other Billing provider info fields have correct information
  6. Click Save profile
  7. Recreate and submit the claim so it uses the updated NPI

Note: If you’re unsure of the billing provider NPI that the payer has on file, contact the payer directly to confirm this. If you need to update the NPI on the enrollment, see How do I update my enrollment information?.

Claim service line requirement errors

A common scrub error can state that certain information, such as the rendering provider’s last name, is required for the claim’s service line. This indicates that one of the service lines was manually removed from the claim.

Manual edits to service lines often cause processing issues. If you need to submit a claim without one of the service lines that was previously included, follow these steps:

  1. Delete the scrubbed claim
  2. Navigate to the client's Overview page and create a new claim
  3. Select the appointment(s) you’d like to bill to the client's payer
List of appointments to select when creating a new claim
  1. Create and submit the claim

Tip: If you aren't seeing an appointment, try expanding the date range.

Diagnosis code errors

A scrub error indicating that more than 4 Diagnosis pointers are not allowed for a claim service line is caused by the diagnosis pointers checked for that service line.

Scrub error showing too many diagnosis pointers on a service line

A maximum of 12 diagnosis codes can be listed on a single claim. These codes populate in box 21 and are pulled from diagnosis information entered in the client’s file.

Note: For more information on how multiple diagnosis codes can be entered for a client, see How do I include multiple diagnoses on claims/superbills?.

Each appointment on a claim is associated with specific diagnosis codes in box 21. These codes are represented by pointers in box 24e of an appointment’s service line. Insurance payers won’t accept more than 4 diagnosis pointers per service line. If more than 4 pointers are checked, the claim will be scrubbed.

Diagnosis pointers displayed in box 24e for a service line

To resolve this:

  1. Click Edit while viewing the claim
  2. For each service line, uncheck any additional pointers in box 24e so that no more than 4 are selected
Service line with a maximum of four diagnosis pointers selected
  1. Click Save
  2. Submit the claim

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