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Claims Validator™

Claims Validator™: Catch Claim Errors Before You Submit

Pre-submission claim validation for independent professional practices.

Validate professional claims before submission with structured checks that help identify missing, inconsistent, or high-risk information before a claim leaves the practice.

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See what your own insurance payment and denial history reveals. Free, with no obligation.

Claims Validator™ interface showing a CMS-1500 professional claim alongside a validation results panel with passed, failed, warning, and not-evaluated checks.

Submit Cleaner Claims with Greater Confidence

  • Guided CMS-1500 claim building
  • Professional claim validation with clear passed, failed, warning, and not-evaluated states
  • HIPAA 837P export for use with an existing clearinghouse
  • Optional Claim.MD submission

Why practices use it

  • Prevent avoidable denials
  • Improve first-pass acceptance
  • Accelerate reimbursement
  • Strengthen cash flow
  • Reduce billing rework
  • Minimize administrative burden
  • Protect earned revenue
  • Improve staff productivity
  • Gain confidence before submission
  • Spend more time with patients

How it works

  1. Build or prepare the claim. Enter professional claim information through the guided workflow or prepare claim data for validation.
  2. Validate and correct. Review errors, warnings, passed checks, and items not evaluated before submission.
  3. Export or submit. Export a HIPAA 837P file for an existing clearinghouse or use optional Claim.MD submission.*

Works with your existing clearinghouse. Customers may validate and export HIPAA 837P files for use with platforms such as Change Healthcare/Optum, Office Ally, Availity, Waystar, TriZetto, and others. *Claim.MD submission is optional.

After payment, ERA Analyzer™ shows how your claims were adjudicated.

Denials that often trace back to claim data

Many avoidable denials start with missing, invalid, or inconsistent information on the claim itself. These guides explain what each code means and how to prevent it.

  • CO-16: Claim/service lacks information or has submission/billing error(s).
  • CO-4: The procedure code is inconsistent with the modifier used.
  • CO-11: The diagnosis is inconsistent with the procedure.
  • CO-5: The procedure code/type of bill is inconsistent with the place of service.
  • OA-18: Exact duplicate claim/service (Use only with Group Code OA except where state workers' compensation…
  • N290: Missing/incomplete/invalid rendering provider primary identifier.
  • N286: Missing/incomplete/invalid referring provider primary identifier.
  • MA130: Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the…

Look up any denial or remark code →

Built for Independent Providers and Practices

ClaimsRevenue™ is designed for independent professional healthcare providers and practices that submit professional claims and receive ERA files.

  • Medical practices: Independent physicians, physician groups, nurse practitioners, physician assistants
  • Behavioral health: Therapists, counselors, and behavioral health practices
  • Rehabilitation: Physical therapy, occupational therapy, and speech-language pathology
  • Other professional practices: Chiropractic and other independent professional healthcare practices

See pricing: every plan includes both Claims Validator™ and ERA Analyzer™.

Claims Validator™ FAQ

What does Claims Validator™ evaluate?

Claims Validator™ evaluates supported professional-claim rules and identifies results as passed, failed, warning, or not evaluated. It is designed to show what was checked and what still requires professional review.

Does a successful validation guarantee that a claim will be accepted or paid?

No. Validation can identify supported claim issues, but it cannot guarantee clearinghouse acceptance, payer acceptance, adjudication, coverage, reimbursement, or payment. Payer rules and claim outcomes depend on factors outside ClaimsRevenue™'s control.

Does Claims Validator™ check every payer rule?

No. ClaimsRevenue™ evaluates supported validation rules. Payer requirements, edits, policies, and coverage rules can change and may not all be available to or evaluated by the platform. Customers remain responsible for compliance with applicable payer requirements.

What types of claims does ClaimsRevenue™ support?

ClaimsRevenue™ currently supports professional claims, including CMS-1500 claims and HIPAA 837P transactions. Institutional claims, such as UB-04/837I claims, and dental claims are not currently supported.

Are claim validations and ERA imports limited?

Current subscription plans include unlimited use of Claims Validator™ and unlimited ERA imports, subject to the Terms, applicable plan features, and reasonable-use and technical limitations.

Can I use my existing clearinghouse?

Yes, if your clearinghouse can accept the HIPAA 837P file generated by ClaimsRevenue™. Compatibility, enrollment requirements, payer connectivity, and submission rules are determined by the applicable clearinghouse and payer.

Does ClaimsRevenue™ replace my clearinghouse?

Not necessarily. ClaimsRevenue™ can export HIPAA 837P files for use with compatible healthcare clearinghouses. Optional integrated clearinghouse services may also be available for eligible customers.

Who is responsible for the accuracy of claim information?

The customer is responsible for the accuracy, completeness, authorization, coding, documentation, provider information, patient information, and other data submitted through ClaimsRevenue™.

See what your own insurance payment and denial history reveals. Free, with no obligation.

Schedule Your Free Claims Analysis Start Subscription

See what your own insurance payment and denial history reveals. Free, with no obligation.