ABA Claim Scrubber Checks: 18 Errors That Block a Claim and 6 Warnings That Need a Second Look

A clean claim rate is decided before the claim leaves the building. TargetFlo's Billing → Claims queue re-checks every claim each time it changes. Here is everything it checks.

Errors — the claim can't go until they're fixed

1. No lines on the claim
2. Billing identity incomplete — billing name, NPI, taxonomy, EIN, address or phone missing in billing settings
3. Payer rule inactive
4. Payer ID missing
5. Member ID missing
6. Subscriber name missing
7. Patient date of birth missing
8. Patient gender missing
9. Diagnosis missing (no primary ICD-10 code active on the date of service)
10. Rendering NPI missing
11. Date of service in the future
12. Date of service outside the authorization
13. Zero units
14. Zero charge
15. More than four modifiers
16. Invalid modifier
17. Duplicate line — same date, code, client and rendering provider on another live claim
18. Past timely filing

Warnings — approve only after a person looks

1. No authorization on a charge that was released by hand
2. Released charge — a held charge someone overrode
3. Unexpected modifier
4. Same-day repeat of a code
5. Subscriber assumed to be the patient
6. Timely filing soon — 14 days or fewer left

How the queue uses the results

• Errors → Draft. Warnings, or a "review all" setting → Needs review. Clean → approved (shadow payers) or waiting for a person (live payers).
• Approving re-checks first; warnings must be acknowledged one claim at a time — bulk approve never acknowledges them.
• Claims are grouped weekly (client + insurance + payer + rendering provider, up to 50 lines) or one per session.

Related: Why ABA charges get held · ABA clearinghouse checklist · Billing & Claims