The Cost of Dirty Claims on Revenue Cycles

Our AI claim scrubbing software delivers automated claim validation across coding accuracy, payer edits, NCCI compliance, eligibility verification, and authorization checks before submission. Reduce preventable denials, improve clean claim rates, and lower repetitive billing rework across high-volume healthcare revenue cycle operations.

15–25%

Of Claims Require Rework After Submission

Industry benchmarks show most healthcare organizations achieve clean claim rates between 85–90%. That means up to 15% of claims require correction before payment — costing $118 per reworked claim. AI-powered claim scrubbing helps significantly reduce this rework.

$25.7B

Annual Cost of Claims Adjudication & Rework

Healthcare providers spend over $25.7 billion annually on claims adjudication, denials, and resubmissions — a 23% increase from the previous year. Most of this is preventable with pre-submission validation.

68%

Of Providers Say Clean Claims Are Harder Than Ever

Payer rules are evolving faster than manual teams can track. CMS updates NCCI edits quarterly. Commercial payers change coverage policies constantly. Without automated claim validation, billing teams are always one step behind.

AI-Powered Claim Scrubbing and Error Prevention

The Claims Scrubbing Agent goes beyond traditional clearinghouse edits and static rules engines. It’s an AI-powered validation layer that performs automated claim scrubbing across coding accuracy, payer rules, regulatory compliance, eligibility, and clinical logic before claims reach submission workflows. AI claim error prevention built for cleaner claims processing at scale.

Ingests claims from EHR, PM, and billing systems for automated claim validation before submission.

Validates CPT, HCPCS, ICD-10, modifiers, and diagnosis pairings against coding and bundling logic.

Applies NCCI edits, MUE limits, LCD/NCD policies, and regulatory compliance checks automatically.

Checks payer-specific rules, authorization requirements, benefits, and coverage policies on every claim.

Verifies eligibility, demographics, COB order, and insurance status in real time to reduce preventable denials.

Flags claim errors, suggests corrections, and routes clean claims for payer submission workflows.

Traditional Claim Editing

Basic NCCI edits only

Static rules with manual updates

Catches only obvious formatting errors

Same rules applied across all payers

AI Claims Scrubbing Agent

Multi-dimensional validation: coding + payer rules + clinical logic

Real-time rule updates from CMS and payers

AI-driven claim error prevention before submission

Payer-specific adjudication intelligence

AI Claim Scrubbing Built for Error-Free Claims Processing

AI-powered workflows that automate coding validation, payer rule checks, eligibility verification, and claim accuracy review before submission across healthcare revenue cycle operations.

Claims Intake & Validation

Ingests, parses, and validates claims from EHRs, PM systems, and billing workflows before submission. Field-level extraction, coding validation, and multi-layer automated claim validation run continuously across the claims queue.

Coding & Compliance Validation

Validates CPT, HCPCS, and ICD-10 codes against NCCI edits, MUE limits, LCD/NCD policies, and diagnosis pairing rules. AI claim error prevention identifies bundling violations, missing modifiers, and coding mismatches before submission.

Payer Rules & Adjudication

Applies payer-specific coverage policies, authorization requirements, formatting logic, and plan-level benefit rules on every claim. Automated claim scrubbing delivers seamless claim validation across complex multi-payer environments.

Error Prioritization & Resolution

Scores claim errors by financial impact, denial probability, and filing urgency while routing corrections through AI claim prioritization and automated error resolution workflows. High-severity issues escalate instantly while low-severity errors route for correction automatically.

EHR & Payer Connectivity

Connects with EHRs, billing systems, clearinghouses, and payer workflows through APIs, HL7/FHIR, and real-time synchronization. Native AI claim scrubbing integration with Epic, Cerner, AthenaHealth, and existing healthcare infrastructure.

AI Agents Built for Revenue Cycle Teams

80% Reduction in Staff Time on Payer Calls

100% Automated Claim Status Tracking

Your Revenue Cycle, Running on Autopilot.

OSP's Agentic AI Revenue Engine automates the most repetitive task in your billing workflow — calling payers to check claim status. It makes the calls, captures the updates, and reports everything in real time, so your team spends zero time on hold.

What It Does:

Automatically calls payers to check claim status
Captures claim updates without any manual follow-up
Logs and reports claim status directly to an Excel sheet
Replaces hours of staff time spent on hold with payers

See It In Action

4x Faster Denial Resolution with AI

5x Reduction in Denial Management Workload

Stop Writing Off Denied Claims. Start Recovering Them.

OSP's RCM Revenue Engine pulls denied claims from any source — EHR, clearinghouse, or manual upload — uses AI to identify the root cause, determines the best course of action, and automates the entire resolution workflow.

What It Does

Identifies root cause of every denial using AI
Auto-generates appeal letters tailored to payer requirements
Resubmits claims or routes complex cases to staff
Tracks every denial from identification to resolution

See It In Action

Connects to Your Existing EHR, Billing, and Payer Systems

Your current systems stay exactly where they are. OSP’s AI agents connect directly to your EHR, billing platform, clearinghouse, and payer stack through native integrations. We integrate directly with your existing healthcare infrastructure so AI claim scrubbing workflows operate inside the billing, coding, and revenue cycle systems your teams already use every day.

No Rip-and-Replace

We integrate directly with your existing healthcare infrastructure so AI workflows operate inside the platforms your teams already use every day.

Your Existing Ecosystem

EHR & Clinical Systems

Billing & Practice Management Platforms

Clearinghouses & Claims Infrastructure

Payer Rules & Adjudication Workflows

Revenue Cycle & Financial Operations

AI Claim Scrubbing Workflows

Automated Claim Validation

AI Claim Error Prevention

Real-Time Payer Rule Checks

Automated Error Resolution

Continuous Clean Claim Optimization

Solutions We Delivered

Claims Data Management Solutions

Built a cloud-based claims data management platform to centralize healthcare claims processing, improve data visibility, and streamline payer communication across distributed systems.

65%

Faster Claims Data Access

View Case Study

Transforming Billing for FQHC Clinics

Developed a secure, HIPAA-compliant claims management platform to automate billing, coding, reimbursement workflows, and denial tracking for a dental FQHC clinic.

KEY BILLING OUTCOMES IMPROVED

View Case Study

Automated Claim Review System

Developed an automated and cloud-based claim review system to identify errors and avoid long turn-around time.

100%

Error-free EORs

View Case Study

Mental Health PM+RCM Solution

Built a customized solution to improve revenue cycle and practice management workflows in a mental-health center.

55%

reduction in claims losses

View Case Study

For the Teams Running Real Revenue Cycles

Best fit for RCM firms, provider groups, and hospital networks managing complex claims operations across multi-payer revenue cycle environments.

RCM Firms & Billing Companies

Run more books with the same headcount. AI claim scrubbing automates coding validation, payer rule checks, eligibility verification, and automated claim validation workflows across high-volume claims operations.

Learn More

High-Volume Providers & Multi-Location Groups

Scale clean claim operations without scaling billing teams. Built for group practices, specialty chains, and hospital networks managing complex multi-payer claim validation workflows. Supports enterprise claim governance, payer compliance, and multi-system revenue cycle operations.

Learn More

Provider Revenue Cycle Teams

Reduce preventable denials, improve first-pass claim acceptance, and lower repetitive billing rework without increasing administrative headcount across revenue cycle operations.

Learn More

Hear From Our Clients

We've reached out and found companies like OSP to create our technology. This is my first time working with a company that has been so thorough. These guys are amazing. If you really are looking for someone for a technology solution, these guys are the real deal.

Stephen Carter

Co-Founder Home Health Pro

We approached OSP for a technology solution estimate and were impressed by their professionalism and clarity. Confident in their approach, we moved forward quickly. Their team stayed on schedule and within budget, providing regular updates. For future development needs, OSP will be our first choice.

Selita Jansen

Vice President Operations Health Solutions, LLC

Voi is dedicated to ending suicides globally with two solutions: Voi Detect, a validated suicide risk assessment, and Voi Reach, an AI-driven support app. OSP played a crucial role in transforming our concepts into commercially successful, award-winning solutions. I sincerely appreciate their invaluable support.

Rick Johnson

CEO, Voi Health

Frequently Asked Questions

How does AI improve claim accuracy and reduce claim errors?

AI reviews claims against coding rules, NCCI edits, payer policies, and eligibility requirements before submission. Automated claim validation catches errors early to improve clean claim rates and reduce preventable denials across revenue cycle operations.

How does AI automatically detect and correct claim errors?

AI runs each claim through multiple validation layers in real time. Simple issues can be auto-corrected while complex errors route to billers with recommended fixes through automated claim scrubbing workflows.

What impact does AI-driven claim scrubbing have on claim resolution?

Automated claim scrubbing improves clean claim rates, reduces repetitive rework, and accelerates reimbursement workflows by preventing coding, eligibility, and payer-rule errors before submission.

How does AI claim scrubbing integrate with Epic and existing RCM systems?

Native AI claim scrubbing integration supports Epic, Cerner, AthenaHealth, clearinghouses, and billing systems through HL7/FHIR APIs and real-time workflow synchronization without replacing existing infrastructure.

What advanced capabilities does AI claim scrubbing software provide?

AI claim scrubbing software includes payer-specific adjudication intelligence, denial prediction scoring, automated claim validation, clinical code relationship analysis, and continuous learning from denied claims.

How does AI reduce claim rework and administrative costs?

AI claim scrubbing identifies coding, eligibility, and payer-rule errors before submission, reducing repetitive rework and helping revenue cycle teams lower manual error-handling costs.

How does AI help prevent claim denials?

AI claim error prevention validates coding accuracy, payer requirements, NCCI compliance, and eligibility before claims reach payer submission workflows, reducing preventable denials caused by manual validation gaps.

How does AI claim scrubbing compare to manual claim validation?

Compared to manual claim validation, AI enables real-time payer rule validation, automated claim scrubbing, and scalable workflow consistency without expanding repetitive manual review operations.

Where can healthcare organizations learn more about AI claim scrubbing?

Explore AI claim scrubbing case studies, ROI frameworks, CMS/CAQH benchmark reports, and operational insights on AI for claims and healthcare claim validation workflows.

What are the emerging trends in AI claim scrubbing?

AI claim scrubbing solutions are evolving toward predictive denial scoring, payer-specific adjudication models, real-time compliance validation, and continuous learning across healthcare revenue cycle workflows.

Ready to Automate Claim Scrubbing?

Tell us about your RCM stack, claim volumes, payer mix, and current clean claim rates. We’ll show you how AI claim scrubbing and automated claim validation reduce preventable denials, improve claim accuracy, and lower repetitive billing rework across revenue cycle operations.

30-minute live walkthrough using your claim types and payer mix

ROI estimate based on current denial volume and rework costs

Integration plan for your existing EHR, PM, and billing systems

Clean claim rate improvement projections for your payer environment

Automate Claims Scrubbing.
Reduce Revenue Leakage.

The Cost of Dirty Claims on Revenue Cycles

AI-Powered Claim Scrubbing and Error Prevention

Ingests claims from EHR, PM, and billing systems for automated claim validation before submission.

Validates CPT, HCPCS, ICD-10, modifiers, and diagnosis pairings against coding and bundling logic.

Applies NCCI edits, MUE limits, LCD/NCD policies, and regulatory compliance checks automatically.

Checks payer-specific rules, authorization requirements, benefits, and coverage policies on every claim.

Verifies eligibility, demographics, COB order, and insurance status in real time to reduce preventable denials.