Claim Scrubber

Scrubber rules describe problems that should stop or flag an insurance claim before it is submitted to a clearinghouse. Every claim is scrubbed against the account's active rules when it is submitted, and a claim can also be scrubbed on demand.

The scrubber rule model

A rule is a name and a set of conditions describing a problem. When the conditions hold for a claim, or for one of its billing items, the claim is flagged with the rule's message. A rule that mentions a billing item field (procedure, modifiers, units, and so on) runs once per billing item; a rule that only mentions claim fields runs once per claim.

Properties

Name
id
Type
string
Description
Unique identifier for the scrubber rule.
Name
object
Type
string
Description
Always 'scrubber_rule'.
Name
name
Type
string
Description
Name of the rule.
Name
description
Type
string
Description
Description of what the rule checks.
Name
severity
Type
string
Description
An 'error' finding blocks submission of the claim. A 'warning' finding is recorded but does not hold the claim back.
Possible values:
error
warning
Name
source
Type
string
Description
'system' rules are standard rules provided by Avon. Their conditions cannot be edited. Rules created through the API are 'custom'.
Possible values:
system
custom
Name
conditions
Type
array of arrays of objects
Description
The problem the rule looks for, as an OR of AND blocks: the outer array is OR, each inner array is AND. Each condition object has an id string, a field, a condition (operator), and a value. See the condition grammar below.
Name
message
Type
string
Description
The message shown on a finding raised by this rule.
Name
start_date
Type
date
Description
Optional. The rule only evaluates claims with service dates on or after this date.
Name
end_date
Type
date
Description
Optional. The rule only evaluates claims with service dates on or before this date.
Name
status_history
Type
array of objects
Description
Status history of the scrubber rule.
Name
created_by
Type
string
Description
Creator of the scrubber rule.
Name
created_at
Type
date-time
Description
Timestamp (in ISO 8601 format) of when the scrubber rule was created.
Name
last_updated_at
Type
date-time
Description
Timestamp (in ISO 8601 format) of when this scrubber rule was last updated.

Response

{
    "id": "scrb_02DCBCXf3BglWGW0eC3H",
    "object": "scrubber_rule",
    "name": "Telehealth 99213 requires modifier 95",
    "description": "Office visits billed with place of service 02 must carry the telehealth modifier.",
    "severity": "error",
    "source": "custom",
    "conditions": [
        [
            { "id": "c1", "field": "procedure", "condition": "equal_to", "value": "99213" },
            { "id": "c2", "field": "place_of_service", "condition": "equal_to", "value": "02" },
            { "id": "c3", "field": "modifiers", "condition": "not_in", "value": ["95"] }
        ]
    ],
    "message": "Add modifier 95 for telehealth visits.",
    "start_date": "2026-01-01",
    "end_date": null,
    "status_history": [
        {
            "status": "draft",
            "changed_by": "user_idjkvxZTqfJD734feQHa",
            "changed_at": "2026-09-01T13:20:21.724Z"
        },
        {
            "status": "active",
            "changed_by": "user_idjkvxZTqfJD734feQHa",
            "changed_at": "2026-09-02T09:04:11.102Z"
        }
    ],
    "created_by": "user_idjkvxZTqfJD734feQHa",
    "created_at": "2026-09-01T13:20:21.724Z",
    "last_updated_at": "2026-09-02T09:04:11.102Z"
}

The condition grammar

Each condition compares one field of the claim, or of one of its billing items, against a value. Which operators a field accepts is fixed per field.

Fields

Name
payer
Type
string
Description
The payer on the claim. Operators: equal_to, not_equal_to, in, not_in.
Name
procedure
Type
CPT code
Description
Procedure on the billing item. Operators: equal_to, not_equal_to, in, not_in.
Name
modifiers
Type
array of modifiers
Description
Modifiers on the billing item. A list field matches on any entry, so modifiers not_in ["95"] means the billing item does not carry 95. Operators: in, not_in, exists, missing.
Name
units
Type
number
Description
Quantity on the billing item. Operators: exists, missing, greater_than, greater_than_or_equal, less_than, less_than_or_equal.
Name
service_start
Type
number of days
Description
Days between the billing item's service start date and today. Operators: greater_than, greater_than_or_equal, less_than, less_than_or_equal.
Name
service_end
Type
number of days
Description
Days between the billing item's service end date and today. Same operators as service_start.
Name
place_of_service
Type
string
Description
Place of service on the billing item. Operators: equal_to, not_equal_to, in, not_in.
Name
line_diagnoses
Type
array of ICD-10 codes
Description
Diagnoses associated with the billing item. Operators: in, not_in, exists, missing.
Name
same_day_procedures
Type
array of CPT codes
Description
Procedures on other billing items with the same date of service. Operators: in, not_in, exists, missing.
Name
claim_procedures
Type
array of CPT codes
Description
Every procedure on the claim. Operators: in, not_in, exists, missing.
Name
claim_diagnoses
Type
array of ICD-10 codes
Description
Every diagnosis on the claim. Operators: in, not_in, exists, missing.
Name
primary_diagnosis
Type
ICD-10 code
Description
The first diagnosis on the claim. Operators: equal_to, not_equal_to, in, not_in. Also secondary_diagnosis and tertiary_diagnosis.
Name
prior_authorization_number
Type
string
Description
Operators: exists, missing.
Name
referral_number
Type
string
Description
Operators: exists, missing.
Name
service_facility
Type
string
Description
Service facility on the claim. Operators: in, not_in, exists, missing.
Name
billing_provider
Type
string
Description
Billing provider on the claim. Operators: in, not_in, exists, missing.
Name
sex
Type
string
Description
Patient sex. Operators: equal_to, not_equal_to, exists, missing.
Name
patient_age
Type
number of years
Description
Patient age in years. Operators: exists, missing, greater_than, greater_than_or_equal, less_than, less_than_or_equal.
Name
patient_state
Type
string
Description
Patient address state. Operators: equal_to, not_equal_to, in, not_in.

Operators

Name
equal_to
Type
single value
Description
The field is the value.
Name
not_equal_to
Type
single value
Description
The field is not the value.
Name
in
Type
array of values
Description
The field is one of the values. For a list field, any entry matches.
Name
not_in
Type
array of values
Description
The field is not one of the values. For a list field, no entry matches.
Name
exists
Type
no value
Description
The field is present.
Name
missing
Type
no value
Description
The field is absent or empty.
Name
greater_than
Type
number
Description
Also greater_than_or_equal, less_than, and less_than_or_equal.

Unit cap

[
  [
    { "id": "c1", "field": "procedure", "condition": "equal_to", "value": "99213" },
    { "id": "c2", "field": "units", "condition": "greater_than", "value": 2 }
  ]
]

Add-on code

[
  [
    { "id": "c1", "field": "procedure", "condition": "equal_to", "value": "99354" },
    { "id": "c2", "field": "same_day_procedures", "condition": "not_in", "value": ["99213"] }
  ]
]

Authorization

[
  [
    { "id": "c1", "field": "procedure", "condition": "in", "value": ["97110", "97140"] },
    { "id": "c2", "field": "prior_authorization_number", "condition": "missing", "value": null }
  ]
]

Timely filing (OR)

[
  [
    { "id": "c1", "field": "payer", "condition": "equal_to", "value": "00019" },
    { "id": "c2", "field": "service_start", "condition": "greater_than", "value": 90 }
  ],
  [
    { "id": "c3", "field": "payer", "condition": "equal_to", "value": "00039" },
    { "id": "c4", "field": "service_start", "condition": "greater_than", "value": 180 }
  ]
]

POST/v2/scrubber_rules

Create a scrubber rule

Creates a new scrubber rule. A rule starts as a draft unless status is set to 'active'. Drafts are saved as-is and do not run. Activating a rule validates it: it must have at least one condition, every condition needs a field and an operator, and every condition needs a value unless the operator is 'exists' or 'missing'. A rule that fails validation returns a 400 with code invalid_scrubber_rule.

Required attributes

Name
name
Type
string
Description
Name of the rule.

Optional attributes

Name
description
Type
string
Description
Description of what the rule checks.
Name
severity
Type
string
Description
Defaults to 'error'.
Possible values:
error
warning
Name
conditions
Type
array of arrays of objects
Description
The problem the rule looks for. Defaults to an empty set, which is allowed on a draft but not on an active rule.
Name
message
Type
string
Description
The message shown on a finding raised by this rule.
Name
start_date
Type
date
Description
The rule only evaluates claims with service dates on or after this date.
Name
end_date
Type
date
Description
The rule only evaluates claims with service dates on or before this date.
Name
status
Type
string
Description
Defaults to 'draft'.
Possible values:
draft
active

Request

POST

/v2/scrubber_rules

curl -X POST "https://{{base_subdomain}}.avonhealth.com/v2/scrubber_rules" \
  -H "Authorization: Bearer {{token}}" \
  -H "x-jwt: {{jwt}}" \
  -H "account: {{account}}" \
  -H "Content-Type: application/json" \
  --data '{
    "name": "Telehealth 99213 requires modifier 95",
    "severity": "error",
    "message": "Add modifier 95 for telehealth visits.",
    "status": "active",
    "conditions": [
      [
        { "id": "c1", "field": "procedure", "condition": "equal_to", "value": "99213" },
        { "id": "c2", "field": "place_of_service", "condition": "equal_to", "value": "02" },
        { "id": "c3", "field": "modifiers", "condition": "not_in", "value": ["95"] }
      ]
    ]
  }'

Response

    {
        "id": "scrb_02DCBCXf3BglWGW0eC3H",
        "object": "scrubber_rule",
        "name": "Telehealth 99213 requires modifier 95",
        "description": null,
        "severity": "error",
        "source": "custom",
        "conditions": [
            [
                { "id": "c1", "field": "procedure", "condition": "equal_to", "value": "99213" },
                { "id": "c2", "field": "place_of_service", "condition": "equal_to", "value": "02" },
                { "id": "c3", "field": "modifiers", "condition": "not_in", "value": ["95"] }
            ]
        ],
        "message": "Add modifier 95 for telehealth visits.",
        "start_date": null,
        "end_date": null,
        "status_history": [
            {
                "status": "active",
                "changed_by": "user_idjkvxZTqfJD734feQHa",
                "changed_at": "2026-09-01T13:20:21.724Z"
            }
        ],
        "created_by": "user_idjkvxZTqfJD734feQHa",
        "created_at": "2026-09-01T13:20:21.724Z",
        "last_updated_at": "2026-09-01T13:20:21.724Z"
    }

GET/v2/scrubber_rules/:id

Retrieve a scrubber rule

Retrieves the specified scrubber rule.

Request

GET

/v2/scrubber_rules/:id

curl "https://{{base_subdomain}}.avonhealth.com/v2/scrubber_rules/:id" \
  -H "Authorization: Bearer {{token}}" \
  -H "x-jwt: {{jwt}}" \
  -H "account: {{account}}"

Response

    {
        "id": "scrb_02DCBCXf3BglWGW0eC3H",
        "object": "scrubber_rule",
        "name": "Telehealth 99213 requires modifier 95",
        "description": "Office visits billed with place of service 02 must carry the telehealth modifier.",
        "severity": "error",
        "source": "custom",
        "conditions": [
            [
                { "id": "c1", "field": "procedure", "condition": "equal_to", "value": "99213" },
                { "id": "c2", "field": "place_of_service", "condition": "equal_to", "value": "02" },
                { "id": "c3", "field": "modifiers", "condition": "not_in", "value": ["95"] }
            ]
        ],
        "message": "Add modifier 95 for telehealth visits.",
        "start_date": "2026-01-01",
        "end_date": null,
        "status_history": [
            {
                "status": "draft",
                "changed_by": "user_idjkvxZTqfJD734feQHa",
                "changed_at": "2026-09-01T13:20:21.724Z"
            },
            {
                "status": "active",
                "changed_by": "user_idjkvxZTqfJD734feQHa",
                "changed_at": "2026-09-02T09:04:11.102Z"
            }
        ],
        "created_by": "user_idjkvxZTqfJD734feQHa",
        "created_at": "2026-09-01T13:20:21.724Z",
        "last_updated_at": "2026-09-02T09:04:11.102Z"
    }

POST/v2/scrubber_rules/:id

Update a scrubber rule

Updates the specified scrubber rule by setting the values of the parameters passed. Any other parameters not provided will not be modified. Setting status to 'active' validates the rule's conditions before it goes live. The conditions of a 'system' rule cannot be changed; attempting to returns a 400 with code immutable_scrubber_rule.

Required attributes

Optional attributes

Name
name
Type
string
Description
Name of the rule.
Name
description
Type
string
Description
Description of what the rule checks.
Name
severity
Type
string
Description
Severity of findings raised by this rule.
Possible values:
error
warning
Name
conditions
Type
array of arrays of objects
Description
Replaces the rule's condition set. Not editable on 'system' rules.
Name
message
Type
string
Description
The message shown on a finding raised by this rule.
Name
start_date
Type
date
Description
Pass null to clear.
Name
end_date
Type
date
Description
Pass null to clear.
Name
status
Type
string
Description
Status of the rule. Setting this appends an entry to the rule's status history.
Possible values:
draft
active
archived

Request

POST

/v2/scrubber_rules/:id

curl -X POST "https://{{base_subdomain}}.avonhealth.com/v2/scrubber_rules/:id" \
  -H "Authorization: Bearer {{token}}" \
  -H "x-jwt: {{jwt}}" \
  -H "account: {{account}}" \
  -H "Content-Type: application/json" \
  --data '{
    "severity": "warning",
    "status": "active"
  }'

Response

    {
        "id": "scrb_02DCBCXf3BglWGW0eC3H",
        "object": "scrubber_rule",
        "name": "Telehealth 99213 requires modifier 95",
        "description": "Office visits billed with place of service 02 must carry the telehealth modifier.",
        "severity": "warning",
        "source": "custom",
        "conditions": [
            [
                { "id": "c1", "field": "procedure", "condition": "equal_to", "value": "99213" },
                { "id": "c2", "field": "place_of_service", "condition": "equal_to", "value": "02" },
                { "id": "c3", "field": "modifiers", "condition": "not_in", "value": ["95"] }
            ]
        ],
        "message": "Add modifier 95 for telehealth visits.",
        "start_date": "2026-01-01",
        "end_date": null,
        "status_history": [
            {
                "status": "draft",
                "changed_by": "user_idjkvxZTqfJD734feQHa",
                "changed_at": "2026-09-01T13:20:21.724Z"
            },
            {
                "status": "active",
                "changed_by": "user_idjkvxZTqfJD734feQHa",
                "changed_at": "2026-09-02T09:04:11.102Z"
            }
        ],
        "created_by": "user_idjkvxZTqfJD734feQHa",
        "created_at": "2026-09-01T13:20:21.724Z",
        "last_updated_at": "2026-09-02T09:04:11.102Z"
    }

GET/v2/scrubber_rules

List all scrubber rules

Returns a list of all scrubber rules, newest first.

Optional query parameters

Name
status
Type
string
Description
Only return rules whose current status matches.
Possible values:
draft
active
archived
Name
source
Type
string
Description
Only return standard or custom rules.
Possible values:
system
custom
Name
search
Type
string
Description
Free-text search on name.

Request

GET

/v2/scrubber_rules

curl "https://{{base_subdomain}}.avonhealth.com/v2/scrubber_rules?status=active" \
  -H "Authorization: Bearer {{token}}" \
  -H "x-jwt: {{jwt}}" \
  -H "account: {{account}}"

Response

    {
      "object": "list",
      "data": [
        {
            "id": "scrb_02DCBCXf3BglWGW0eC3H",
            "object": "scrubber_rule",
            "name": "Telehealth 99213 requires modifier 95",
            "description": "Office visits billed with place of service 02 must carry the telehealth modifier.",
            "severity": "error",
            "source": "custom",
            "conditions": [
                [
                    { "id": "c1", "field": "procedure", "condition": "equal_to", "value": "99213" },
                    { "id": "c2", "field": "place_of_service", "condition": "equal_to", "value": "02" },
                    { "id": "c3", "field": "modifiers", "condition": "not_in", "value": ["95"] }
                ]
            ],
            "message": "Add modifier 95 for telehealth visits.",
            "start_date": "2026-01-01",
            "end_date": null,
            "status_history": [
                {
                    "status": "active",
                    "changed_by": "user_idjkvxZTqfJD734feQHa",
                    "changed_at": "2026-09-02T09:04:11.102Z"
                }
            ],
            "created_by": "user_idjkvxZTqfJD734feQHa",
            "created_at": "2026-09-01T13:20:21.724Z",
            "last_updated_at": "2026-09-02T09:04:11.102Z"
        },
      ]
    }

DELETE/v2/scrubber_rules/:id

Archive a scrubber rule

Archives the specified scrubber rule. The rule stops running but is not removed, so findings it already raised keep pointing at it.

Required attributes

Optional attributes

Request

DELETE

/v2/scrubber_rules/:id

curl -X DELETE "https://{{base_subdomain}}.avonhealth.com/v2/scrubber_rules/:id" \
  -H "Authorization: Bearer {{token}}" \
  -H "x-jwt: {{jwt}}" \
  -H "account: {{account}}"

Response

    {
        "id": "scrb_02DCBCXf3BglWGW0eC3H",
        "object": "scrubber_rule",
        "archived": true
    }

The scrub result model

A scrub result is one run of the active rules against one insurance claim. Each unmet rule produces a finding. The rule's name is copied onto the finding, so an archived or edited rule never rewrites what a claim was flagged for. Required-field checks always run regardless of configured rules; their findings have a null rule.

Properties

Name
id
Type
string
Description
Unique identifier for the scrub result.
Name
object
Type
string
Description
Always 'scrub_result'.
Name
insurance_claim
Type
string
Description
The insurance claim that was scrubbed.
Name
trigger
Type
string
Description
What started the scrub.
Possible values:
manual
submit
automation
Name
status
Type
string
Description
'passed' when there were no findings. 'failed' when there was at least one. 'overridden' when a failed submit-time scrub was forced through.
Possible values:
passed
failed
overridden
Name
findings
Type
array of objects
Description
One entry per unmet rule. Each finding has: id, object ('scrub_finding'), result, rule (null for built-in required-field checks), rule_name, billing_item (null for claim-level findings), severity, message, outcome ('open', 'dismissed', or 'overridden'), resolved_by, and resolved_at.
Name
created_by
Type
string
Description
User who ran the scrub.
Name
created_at
Type
date-time
Description
Timestamp (in ISO 8601 format) of when the scrub ran.

Response

{
    "id": "scrs_9g36hEN5wgew2M59eIrF",
    "object": "scrub_result",
    "insurance_claim": "iclm_GHY5mso3NpQP90bNHhpp",
    "trigger": "manual",
    "status": "failed",
    "findings": [
        {
            "id": "scrf_tJFm1YU2tWDhpgUhXSZ5",
            "object": "scrub_finding",
            "result": "scrs_9g36hEN5wgew2M59eIrF",
            "rule": "scrb_02DCBCXf3BglWGW0eC3H",
            "rule_name": "Telehealth 99213 requires modifier 95",
            "billing_item": "bitm_Z1zXZKvqrpwxbznuW6lJ",
            "severity": "error",
            "message": "Add modifier 95 for telehealth visits.",
            "outcome": "open",
            "resolved_by": null,
            "resolved_at": null
        }
    ],
    "created_by": "user_idjkvxZTqfJD734feQHa",
    "created_at": "2026-09-08T16:42:03.511Z"
}

POST/v2/insurance_claims/:id/scrub

Scrub an insurance claim

Runs the account's active scrubber rules against the specified insurance claim and returns the result. Nothing is submitted.

Claims are also scrubbed automatically by POST /v2/insurance_claims/submit. Claims with an 'error' finding are held back and moved to 'missing_information'; passing force: true to the submit endpoint overrides the hold and records the findings as overridden.

Required attributes

Optional attributes

Request

POST

/v2/insurance_claims/:id/scrub

curl -X POST "https://{{base_subdomain}}.avonhealth.com/v2/insurance_claims/:id/scrub" \
  -H "Authorization: Bearer {{token}}" \
  -H "x-jwt: {{jwt}}" \
  -H "account: {{account}}"

Response

    {
        "id": "scrs_9g36hEN5wgew2M59eIrF",
        "object": "scrub_result",
        "insurance_claim": "iclm_GHY5mso3NpQP90bNHhpp",
        "trigger": "manual",
        "status": "failed",
        "findings": [
            {
                "id": "scrf_tJFm1YU2tWDhpgUhXSZ5",
                "object": "scrub_finding",
                "result": "scrs_9g36hEN5wgew2M59eIrF",
                "rule": "scrb_02DCBCXf3BglWGW0eC3H",
                "rule_name": "Telehealth 99213 requires modifier 95",
                "billing_item": "bitm_Z1zXZKvqrpwxbznuW6lJ",
                "severity": "error",
                "message": "Add modifier 95 for telehealth visits.",
                "outcome": "open",
                "resolved_by": null,
                "resolved_at": null
            }
        ],
        "created_by": "user_idjkvxZTqfJD734feQHa",
        "created_at": "2026-09-08T16:42:03.511Z"
    }

GET/v2/insurance_claims/:id/scrub

Retrieve scrub results

Returns the most recent scrub results for the specified insurance claim, newest first.

Optional query parameters

Name
limit
Type
number
Description
Maximum number of results to return. Defaults to 1, the latest run.

Request

GET

/v2/insurance_claims/:id/scrub

curl "https://{{base_subdomain}}.avonhealth.com/v2/insurance_claims/:id/scrub?limit=5" \
  -H "Authorization: Bearer {{token}}" \
  -H "x-jwt: {{jwt}}" \
  -H "account: {{account}}"

Response

    {
      "object": "list",
      "data": [
        {
            "id": "scrs_9g36hEN5wgew2M59eIrF",
            "object": "scrub_result",
            "insurance_claim": "iclm_GHY5mso3NpQP90bNHhpp",
            "trigger": "submit",
            "status": "passed",
            "findings": [],
            "created_by": "user_idjkvxZTqfJD734feQHa",
            "created_at": "2026-09-09T10:15:44.020Z"
        },
      ]
    }