Clean claims, first pass.
SubmitClean is a pre-submission check built for chiropractic. It reads the claim you are about to send, checks it against Medicare and commercial payer policy, and tells you in plain English which ones will come back denied, the rule each one breaks, and how long you have to appeal.
Why this exists
Not because chiropractors bill badly. Chiropractic carries more coverage conditions per claim than almost any other specialty, and those conditions change without notice.
What it actually checks
Not “coding edits.” These are the specific coverage conditions that turn a chiropractic claim into a denial.
98940 / 98941 / 98942
Without it, Medicare reads the visit as maintenance therapy and denies it. This is the single most enforced chiropractic rule there is.
M99.00 to M99.05
Level of subluxation primary, the neuromusculoskeletal condition secondary. Reverse them and the claim fails coverage before anyone reads the note.
98941 bills three to four spinal regions. If the diagnoses on the claim only support two, the level is wrong, and it is wrong in a way that shows on the claim itself.
98943, chiropractor-performed E/M, X-ray and PT modalities are excluded under Medicare by statute. Billing them to Medicare is a guaranteed zero.
What you see
Illustrative example, not a real patient or a real audit result. Chart numbers are your own. SubmitClean never sees a patient name.
Who it helps
A denial is not one problem. It is a problem for five people, in sequence, over 45 to 90 days.
Fewer claims bouncing back weeks later. Cleaner submissions mean the money you already earned arrives on the first pass instead of after a resubmission cycle. Revenue you can forecast, not revenue you chase.
Fix a flag in seconds before it goes out instead of working a denial in a queue two months later. Fewer calls to the payer, fewer appeals, less time reconstructing what happened.
Claims arrive already checked. Less rework per client, fewer surprises in aging AR, and a written reason attached to every flag when a client asks why.
Fewer surprise balance bills from a denial nobody caught. A clearer picture up front of what the plan covers and how many visits it allows, so the care plan and the expectation match from the first visit.
How this is different
TriZetto publishes 30,000+ coding edits. Waystar publishes 2.5 million. Neither publishes a single chiropractic-specific rule. A library that size is built for hospitals. The AT modifier is not in anyone’s top 30,000.
Not a score. Not “this claim looks risky.” The rule, the payer, the source document, and the appeal deadline, so your biller can act on it or argue with it. If we cannot point to the rule, we do not flag it.
Every payer rule update is written as a new dated snapshot that can never be edited or deleted. Every clearinghouse says its edits are “continuously updated.” Not one publishes an interval, and none can tell you what their rule said last March. From the day we start tracking a rule, we can show you every day it changed.
All 18 HIPAA Safe Harbor identifiers are stripped inside your office before anything is sent. No names, no birth dates, no calendar dates. If an incoming record even looks like a name or a DOB, the system rejects it. Keeping patient data out is how the system is built, not a promise in a privacy policy.
The landscape, honestly
All of this comes from the vendors’ own published pages. Check any of it.
| Who | What they publish | The gap |
|---|---|---|
| ChiroTouch | Scrubbing comes from its clearinghouse partners: TriZetto on CT ProClear, Change Healthcare on CT MaxClear. Rheo Compliance Scan checks the SOAP note against the codes. | Documentation consistency, not payer policy. No named payer rule, no citation to a source document. |
| Office Ally | Markets “payer-specific edits and built-in validations.” Its own explanation of clearinghouse scrubbing gives format examples: missing payer ID, NPI digits, a birthdate in the wrong format. | Publishes no detail on how deep the edits go, where they come from, or how often they update. |
| ChiroHD | Markets integrated billing and electronic claim submission. | Publishes no detail about claim scrubbing at all. |
| Clearinghouse edit engines (Waystar, Availity, TriZetto, Inovalon) |
Very large general edit libraries. Availity names LCD, NCD and NCCI as edit sources. All report high clean-claim rates. | No chiropractic-specific rule published by any of them, and no published update interval. “Continuously,” “regularly,” “always up to date.” |
| Billing services (5 to 10% of collections) |
Claim submission, denial management, appeals, AR follow-up. | Paid on what eventually gets collected. The model pays for recovery after a denial, not for the denial never happening. |
| Unlimited Systems | The closest published competitor. Markets chiropractic charge review against NCCI, MUE, LCD/NCD and payer edits, including visit limits. | Primarily an oncology RCM vendor. Publishes no example rules and no citations, so the depth cannot be checked from outside. |
Scroll the table sideways on a phone. Sources at the foot of the page.
Before you ask
Anyone selling you billing software should be able to answer this without flinching.
If a claim goes out clean, gets paid, and a post-payment audit later finds the note did not support it, that is a documentation problem, and no claim-level engine can see it. What we catch is what is wrong on the claim itself, which is what gets denied up front, before anyone asks for records.
It sits in front of them. Keep ChiroTouch, keep Office Ally, keep the billing service you like.
SubmitClean is built and running, and we are auditing real practices now. Until that data exists, we will not quote a number. Every percentage on a competitor’s site right now is self-reported and unaudited, including the good ones.
You would be an early practice, not customer number 4,000. That is the trade: you get the audit free and your denial patterns shape the rule set.
We run your last 12 months of claims through SubmitClean and send back a one-page report: which claims would have been flagged, which rule each one breaks, and the dollars attached. Free, with no obligation on the other side of it.
Do your denials arrive electronically, roughly how many claims a year, does your remit history go back a year. Two minutes. If the audit will not be worth your time, we will tell you.
Two small files run on your own computer. Identifying information is stripped before anything is sent. The encryption key and the patient lookup table never leave your PC.
Flagged claims, the rule behind each, the dollars. Pre-authorization denials get their own section.
No patient information is requested here or at any point in the audit.
Most flags are billing fixes. A wrong modifier or diagnosis order goes to whoever does the billing, they correct it in the practice software, and the claim goes out clean. Some flags need the office. When an insurance company requires an authorization, the front desk gets a short note the same day, before the claim goes out, so the paperwork starts while the patient is still in care. The doctor signs the treatment plan and sees a weekly one-pager of what was caught. Nothing more.
Sources
Every figure on this page is linked to its origin. If a number cannot be traced, we do not use it.