8 Claim Scrubbing Innovations Coming in the Next 18 Months

Hi and happy Wednesday,

An RCM team believed their scrubber was performing well. Their clean claim rate held steady at 97 percent, and denials stayed below 5 percent.

But a closer look told a different story. Delays in edits, slow rule updates, and rework after “clean” denials added up to eleven days of trapped cash flow.

Over the next 18 months, that will change. Claim scrubbing is moving toward systems that learn, adapt, and self-correct in real time.

This week, we look at eight innovations that will reshape RCM in the coming months.

1. “Self-Healing” Claim Pipelines

Right now, scrubbing happens before submission.
Soon, scrubbing will be continuous:

• Claims will automatically correct themselves mid-process when new payer rules, missing fields, or code updates appear.

• The system won’t just flag an issue, it will fix it in real time.

• Think of it like a GPS that reroutes your claim to the cleanest path as new roadblocks appear.

Impact: Denials drop sharply. Human billers focus only on unusual cases. Claim submission becomes near “hands-off.”

2. Payer-Provider “Shared Language” Platforms

Today, scrubbing happens in isolation on the provider’s side, and payers apply their own logic later.
We’re likely to see:

• Shared, real-time rulebooks between payers and providers (or certified intermediaries).

• Claims checked against the payer’s actual live system, not your best guess.

• Instant acceptance/rejection decisions, like running your taxes through the IRS checker before filing.

Impact: Less guesswork, faster reimbursements, near-zero first-pass denials.

3. No-Code Custom Rule Builders for Practices

Instead of waiting for vendors or IT teams:

• Practices will be able to build or tweak scrubbing rules themselves- in plain English.

• Example: “Flag all perio claims over $3,000 missing narrative X.”

• AI will translate that into executable logic behind the scenes.

Impact: Frontline staff adapt scrubbing rules in hours, not weeks. Customization becomes effortless.

4. “Denial Twins”: Simulation Before Submission

Think digital twins, but for claims.

• You’ll be able to run your claim through a simulated payer environment that mirrors the real thing.

• It’ll tell you your denial probability before the claim ever goes out.

• If something looks risky, it suggests fixes or routes it through a different workflow.

Impact: Denials predicted (and avoided) with high precision.

5. Real-Time Regulatory Updates as a Service

Payer and regulatory rules are scattered today. In the near future:

• National rule aggregators or clearinghouses will push real-time changes directly into scrubbing engines.

• No more scrambling after a quiet policy shift.

• Everyone works off the same live playbook.

Impact: Massive drop in “policy surprise” denials.

6. “Shadow Billing” Feedback Loops

This is a quieter trend but a powerful one.

• Systems will submit test claims in parallel behind the scenes to learn how payers respond.

• They’ll adjust scrubbing rules based on those outcomes before the real claim goes out.

• Essentially: your scrubbing engine will be learning on live payer behavior continuously.

Impact: Scrubbers evolve in real time without waiting for your team to react.

7. Claims That Carry Their Own Proof

Documentation is currently an afterthought. Soon, claims will:

• Attach structured supporting evidence at the time of submission — clinical notes, narratives, eligibility confirmations — all in one payload.

• Include a built-in audit trail the payer can verify instantly.

• Drastically reduce “missing info” delays.

Impact: Faster approvals, fewer back-and-forths, stronger compliance posture.

8. Denial Prevention > Denial Management

The big mindset shift ahead:

• Instead of reacting to denials, practices will proactively design workflows that prevent them entirely.

• Claims will move toward “autonomous” status: if a claim can’t be fixed automatically, it won’t even be submitted until it’s airtight.

• The system will quietly handle the heavy lifting behind the scenes.

Impact: Fewer appeals, cleaner revenue flow, less dependency on large billing teams.

Next week, I'll be sharing some our new product updates and features.

See you next Tuesday,
Dino Gane-Palmer