Configure Riley's 47 automated billing checks to catch errors before claims are submitted, maximizing your first-pass acceptance rate.
Navigate to Settings > AI Agents > Riley > Pre-Scrub Rules. Here you'll see all 47 checks organized by category: coding accuracy, modifier validation, authorization compliance, eligibility, and payer-specific rules.
Each check can be set to one of three levels: Block (prevents claim submission until resolved), Warning (flags for review but allows submission), or Info (logged but doesn't interrupt workflow). Set critical checks like laterality matching and authorization verification to Block.
Different payers have different requirements. Add custom rules for your top payers — for example, some payers require modifier 59 for certain code combinations while others use modifier XE. PRACTIS includes a library of common payer rules you can activate.
The Pre-Scrub Analytics dashboard shows which checks catch the most errors, your clean claim rate trend, and estimated revenue saved from prevented denials. Use these insights to fine-tune your rules and identify training opportunities for your billing team.
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