Does Sarva auto-correct claims or just flag issues?

Sarva surfaces specific issues with explanations and recommended corrections. For clear formatting or missing modifier issues, Sarva can auto-correct. For clinical judgment decisions like diagnosis code selection, Sarva flags the issue and lets the coder decide.

Can Sarva work alongside our existing claim scrubbing software?

Yes. Sarva can operate as an additional validation layer on top of your existing clearinghouse scrubber or replace it entirely. Many practices use Sarva for its higher specificity and lower alert fatigue compared to traditional scrubbers.

What happens to claims that score high on denial risk?

High-risk claims are routed to coding staff with a specific explanation of what rule was violated and what needs to be corrected. Staff review and correct before submission, preventing the denial from ever reaching the payer.

How often are the validation rules updated?

Sarva continuously monitors payer policy changes, NCCI updates, and LCD/NCD revisions. Rules are updated as changes are published — typically weekly during active policy seasons and at least monthly otherwise.

Use Case

AI Claim Scrubbing to Prevent Denials Before Submission

AI claim scrubbing applies hundreds of payer-specific validation rules to each claim before it is submitted, checking for coding errors, modifier issues, bundling conflicts, medical necessity requirements, and payer-specific edits. Sarva analyzes over 800 data points per claim in under 500 milliseconds, routing high-risk claims for targeted review rather than blind submission.

Review Your Denial Workflow

The Business Problem

Claims are denied because of preventable errors: missing modifiers, incorrect diagnosis-to-procedure linkage, unbundled codes, duplicate charges, and payer-specific formatting requirements. Each denial triggers a rework cycle that adds 14–30 days to the revenue cycle. Worse, some denials are never appealed — the practice simply writes off the revenue.

Affected Team

Billing, coding, and revenue cycle teams. Denial rework consumes the same staff who could be focused on collections and AR follow-up. High denial rates create a backlog that compounds over time.

How It Works

Current Manual Workflow

A coder or biller manually reviews each claim before submission, checking it against their knowledge of payer rules. With hundreds of payers and frequently changing rules, no individual can maintain comprehensive knowledge. Edits are applied inconsistently — what one biller catches, another misses. Claim scrubbing software, if present, generates alert fatigue with low-specificity rules that flag too many claims.

Automated Workflow with Sarva

Sarva ingests the claim data and runs it through 800+ validation rules specific to the destination payer. Rules include NCCI edits, MUE limits, payer-specific LCD/NCD requirements, modifier validation, diagnosis code specificity, and bundling logic. Claims scoring above a configurable risk threshold are routed for targeted review with a specific explanation of what needs attention — not a generic alert.

Inputs

Claim data (CPT, ICD-10, HCPCS, modifiers)
Payer-specific rule sets
Patient demographics and eligibility
Provider credentials and NPI
Place of service codes

Outputs

Risk score per claim (0–100)
Specific rule violations with explanations
Recommended corrections
Clean claim ready for submission
Denial risk flags by category

Human Oversight

High-risk claims are routed to coding staff with specific guidance on what to review. Sarva does not auto-correct clinical judgment — it surfaces the issue and lets the coder decide. Low-risk claims pass through without manual touch, freeing staff for complex cases.

Security Considerations

Claim data is processed in an isolated, encrypted environment. No claim data is shared between customers. All processing is logged with full audit trails. Sarva maintains SOC 2 Type II and HIPAA compliance with a signed BAA.

Integration Considerations

Sarva integrates with your clearinghouse or directly with your practice management system. It works alongside existing claim scrubbing tools as an additional validation layer or replaces them entirely. The 800+ rule library is continuously updated as payer policies change.

Limitations

Claim scrubbing cannot catch every denial cause. Clinical documentation insufficiency, medical necessity disputes, and payer-specific retrospective audits are not fully preventable through pre-submission validation. Sarva reduces preventable denials but cannot eliminate all denial categories.

Key Performance Indicators

First-pass acceptance rate

Target

> 94%

Preventable denial rate

Target

< 3%

Claims scrubbed per hour

Target

Unlimited (automated)

Staff hours on rework

Target

60% reduction

See how this workflow applies to your practice.

Review Your Denial Workflow

Related Connectors

Frequently Asked Questions

Sarva applies over 800 payer-specific rules covering NCCI edits, MUE limits, modifier validation, diagnosis-to-procedure linkage, payer-specific LCD/NCD requirements, and bundling logic. Rules are continuously updated as payer policies change.