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

Note: Scrubbed claims won’t incur a $0.25 fee as they weren’t sent to the payer. If the claim appears as Rejected, this means that the claim had passed our system and was sent to the payer, but the payer didn’t process the claim. For more information on rejected claims, see Resolving claim rejections.

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

• NPI required errors
• NPI not enrolled
• Claim service line requirement errors
• Address & zip code errors
• Diagnosis code errors

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 Organization (Type 2) NPI. 

To have your rendering provider NPI populate claims:

• Navigate to Settings > Profile & Security > Clinical
• Enter your rendering provider NPI Number under Clinician Information

• Click Save Information

To have your billing provider NPI populate claims:

• Navigate to Settings > Billing and Services > Insurance
• Click Edit next to your default Billing provider info 

• Select Individual if your billing provider NPI is your Type 1 NPI, or Organization if your billing provider NPI is your Type 2 NPI
• Enter your NPI 

• Confirm the billing provider name, taxonomy code, and address listed are correct 
• Click Save profile 

Note: If you’re using billing profiles to populate unique billing information for specific payers and/or clinicians, verify that the correct NPIs and billing information are also entered in the billing profiles. For more information, see Managing billing profiles for insurance. 

Once you’ve saved this 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 you’re billing provider NPI is your Type 1, it’s expected that the same NPI will be listed in both boxes. 

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

Note: For more information on entering your billing information, see Entering your billing information.

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, this means that 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. 

If you’ve already submitted a claim filing enrollment with the payer, navigate to Settings > Insurance and click Manage next to the payer to check the status of your enrollment. If the status says Submitted or Document required, this means that the enrollment hasn’t been accepted.

We'll email you when your enrollment has been accepted or if there are any other steps needed from you to complete this process. 

If your enrollment is accepted and you’re still receiving this scrub error, this is because the claim is being submitted with a billing provider NPI that’s different from the NPI the enrollment was accepted under. 

In this case, review the billing provider NPI that’s listed on the enrollment. To do this:

• Navigate to Settings > Insurance
• Click Manage next to the payer 

• Click Manage enrollment under the claim filing enrollment

• Click Review Enrollment Details 

The next page will show the billing information that was submitted on the enrollment, including the NPI.

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:

• Delete the scrubbed claim
• Navigate to Settings > Billing and Services > Insurance
• Click Edit next to your default Billing provider info

• Update the NPI to match the NPI that the enrollment is accepted under

• Make sure that all other Billing provider info fields have correct information
• Click Save profile 

Note: If the payer is associated with a billing profile, you can edit the billing profile to reflect the correct billing provider NPI and information. For more details, see Editing a billing profile.

• Recreate the claim
  • The corrected NPI will appear in box 33
• Submit the claim

Note: If you’re unsure of the billing provider NPI that the payer has on file for you, 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 scrub error 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: 

• Delete the scrubbed claim
• Navigate to the client's Overview page > Billing tab
• Click New > Claim/CMS1500

• Select the appointment(s) you’d like to bill to the client's payer

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

• Create and submit the claim

Address & zip code errors

Another typical scrub error will state that the dependent, subscriber, or billing provider’s zip code is invalid, and that it could not find the full 9-digit zip code. This means that the client or billing provider address is invalid for processing.   

When claims are filed electronically, most payers require a full 9-digit zip code for all addresses. 

Our system will automatically validate an address entered in your settings and populate the 4-digit extension on a claim. However, a scrub error might occur if an address was incorrectly entered, or if the address is manually edited on the claim. An invalid address may indicate:

• Extra characters in the street address
• Street address abbreviations that don’t match the USPS database's record (for example, Lane was entered, and the official address is LN)
• An inaccurately entered full 9-digit zip code

To validate an address, use Look Up a ZIP Code from USPS to see how it appears in the USPS database, along with its 9 digit zip code.

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 the claim service line.

A maximum of 12 diagnosis codes can be listed on a single claim. These codes will 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.

To resolve this: 

• Click Edit while viewing the claim
• For each service line, uncheck any additional pointers in box 24e
  • Make sure only 4 are checked

• Click Save
• Submit the claim