Medical Coding Services
Claims Auditing
& Claims Appeal
Services
Chase Clinical Documentation reviews claims held by bill scrubbers, investigates coding and billing errors, and provides clinical appeals support for high-dollar denials helping healthcare organizations address revenue that might otherwise be written off.
Understanding the Issue
Why Claims Get Held, Denied, or Delayed
Hospitals, physician centers, urgent care centers, and emergency clinics may encounter claims held by bill scrubbers for a variety of coding and billing reasons. Identifying the source of each issue and having the internal resources to correct it can be challenging for busy revenue cycle teams.
Common reasons claims are flagged or delayed:
- NCCI edits (National Correct Coding Initiative)
- Modifier requirements not met
- Medical necessity code requirements
- Duplicate charges
- Missing procedures
- Missing or incomplete dates and times
- Medically unlikely edits
Potential Impact on Your Organization
Unresolved claim issues may contribute to denied charges or revenue that organizations write off due to internal constraints not necessarily because the claim is invalid.
Our Approach
How Chase Claims Auditing Works
Chase takes a structured, documentation-first approach to reviewing claims held by bill scrubbers or denied by payers.
Claims Review
Common Claims Issues We Help Identify
Chase reviews claims across the full range of coding and billing issue types that may cause claims to be held or denied by bill scrubbers and payers.
NCCI Edits
National Correct Coding Initiative edits flag procedure code combinations that should not be billed together. Conflicting code pairs may be held pending review and correction.
Modifier Requirements
Incorrect, missing, or unsupported modifiers can cause a claim to be flagged or reduced. Chase reviews modifier usage against documentation and payer requirements.
Medical Necessity
Payers require that diagnosis and procedure codes support medical necessity. Mismatched or insufficient documentation can result in claim denial or hold.
Duplicate Charges
Duplicate billing entries may be flagged by scrubbers or payers. Chase identifies potential duplicate charges for investigation and appropriate correction.
Missing Procedures
Claims missing required procedure codes may be held or returned. Chase reviews whether procedure documentation is present and accurately reflected in the claim.
Missing Dates or Times
Certain claim types require specific date and time information. Incomplete or missing values can cause claims to be flagged or held by the payer or scrubber.
Medically Unlikely Edits
MUE flags indicate procedure units exceeding expected clinical norms. Chase reviews supporting documentation to determine whether the claim is accurate.
Documentation-First Review
Connecting Claims Review With Clinical Documentation
Many claims issues cannot be resolved by looking at the claim alone. The underlying medical record documentation is often the key to understanding whether a coding or billing correction is supported.
Chase's background in medical coding and clinical documentation positions our team to connect claim-level review with the actual medical record reviewing whether the documentation supports the codes, modifiers, and procedures on the claim, and identifying where gaps or corrections may exist.
This integrated approach combining claims review with medical transcription and coding expertise is a key reason healthcare organizations work with Chase on complex claim issues.
Claims Review Pathway
Denial Appeals
Claims Appeal Services for High-Value Denials
Clinical appeals of high-dollar denials are a specialized service Chase provides to clients. When a payer denies a significant claim, the appeal process requires careful review of both the billing record and the supporting clinical documentation.
Chase has worked with clients to successfully pursue denial overturns at minimal expense to their organization. Our team reviews the claim, the denial reason, and the underlying medical record to identify supporting information and pursue the appropriate appeal pathway.
This service pairs naturally with our broader denials and appeals and medical coding services.
Talk to a Claims SpecialistWhat Chase Reviews in a Clinical Appeal
Revenue Cycle
How Claims Auditing Supports the Revenue Cycle
Effective claims auditing can help healthcare organizations address coding and billing errors before they result in write-offs and identify claims that may be recoverable with the right review and correction. While outcomes vary, a structured approach to claim review can support cleaner submissions and stronger denial workflows.
Chase supports the revenue cycle through claims review and appeal services. Specific recovery outcomes depend on individual claim circumstances.
Why Chase
Why Healthcare Organizations Choose Chase
Years of Experience
More than four decades of healthcare documentation and coding expertise supporting organizations across the U.S.
Experienced Coders & Auditors
Chase's team includes certified, experienced coders and auditors with expertise in medical billing audit and claims review.
Coding, Billing & Appeals
Chase covers medical coding, forensic billing, and denials & appeals supporting the full claim lifecycle.
No Long-Term Contracts
Per-month or per-hour pricing with no long-term contracts. A 5-day training period is included at no charge.
Chase Clinical Documentation's experienced professionals have been providing the highest quality clinical documentation and customer service for more than 40 years supporting hospitals, physician organizations, urgent care centers, and emergency clinics across the revenue cycle.
Common Questions
Frequently Asked Questions
Claims auditing is the systematic review of submitted medical claims to identify billing, coding, and documentation errors that may cause claims to be held, delayed, or denied by payers or bill scrubbers. The goal is to identify correctable issues and support accurate claim resolution.
A medical claims audit reviews the submitted claim, associated medical record documentation, coding accuracy, modifier usage, medical necessity requirements, procedure completeness, date/time accuracy, and payer-specific billing rules.
Bill scrubbers hold claims when they detect potential errors such as NCCI edit conflicts, incorrect or missing modifiers, medical necessity issues, duplicate charges, missing procedure codes, incomplete date or time information, or medically unlikely edit flags.
NCCI (National Correct Coding Initiative) edits are CMS-defined coding policies that identify procedure code combinations that should not be billed together under standard billing rules. Claims containing conflicting code pairs may be held or denied until the issue is reviewed, documented, and corrected or properly modified.
Yes. Claims auditing can help identify the root cause of denials and delays — whether caused by coding errors, documentation gaps, modifier issues, or payer-specific requirements — and support the correction and resubmission process where appropriate.
Claims auditing focuses on reviewing and correcting billing and coding errors — before or after a claim is processed. Claims appeals involve formally disputing a payer's denial decision, typically by submitting supporting clinical documentation to demonstrate medical necessity or billing accuracy. Chase provides both services.
Yes. Chase provides clinical appeals services for high-dollar denials, reviewing the claim and associated medical record documentation to identify supporting information and assist clients in pursuing appropriate appeal activity. Chase has worked with clients to successfully pursue denial overturns at minimal expense to their organization.
