Claims that clear on the first pass
18 deterministic rules check every claim against NCCI, MUE, MPFS, LCD, and ICD-10 before you submit. Every flag links to a CMS source document. The SDK de-identifies PHI locally, so no BAA is required.
No PHI on our servers. By design.
The Submit Shield SDK strips all 18 HIPAA identifiers on your machine before any data reaches our API. Your patients' protected health information never leaves your network, which means you do not need a Business Associate Agreement to use Submit Shield.
What your current scrubber isn't telling you
Denials cost SMB practices an average of $25 per rework. These are the gaps that let preventable denials through.
Denials discovered too late
Most scrubbers run after submission. By the time you see the remittance, the denial is 30 days old and the appeal window is closing.
Black-box logic
Commercial rules engines hide their reasoning. When a claim is flagged, you cannot trace the rule back to a CMS source document.
PHI exposure risk
Cloud scrubbers ingest raw patient data, requiring a BAA and creating a breach surface you have to monitor.
Per-claim pricing surprises
Variable pricing means your cost scales unpredictably with volume. One busy month can blow the budget.
False positives waste time
When clean claims get flagged, your billers waste hours reviewing non-issues. Low specificity erodes trust in the tool.
Narrow rule coverage
Many scrubbers cover NCCI edits and stop there. They miss MUE limits, LCD criteria, MPFS status indicators, and modifier logic.
Three steps to touchless claims
Install the SDK, point it at your claims, and fix issues before you file. No manual uploads, no portal logins.
Install the SDK
Choose your integration path. The SDK de-identifies PHI on your machine before anything leaves your network. No BAA required.
# Python
pip install submitshield
# Docker (folder-watcher)
docker run -v ./claims:/watch submitshield/sdk
# Windows installer
submitshield-setup.exeSubmit claims for validation
Send claims in any of 5 supported formats: 837P, FHIR R4, CSV, canonical JSON, or X12 835. The SDK handles format detection automatically.
from submitshield import SubmitShield
client = SubmitShield()
verdicts = client.validate("claims.csv")
print(f"{len(verdicts)} claims checked")Fix before you file
Each flagged claim returns the rule ID, a plain-English explanation, and a direct link to the CMS source document. No guesswork.
{
"claim_id": "CLM-2024-4821",
"status": "flagged",
"flags": [
{
"rule": "NCCI-PTP-097",
"message": "CPT 99214 bundled with 99213",
"source": "https://cms.gov/ncci-ptp"
}
]
}18 rules across 12 CMS rule families
Every validation maps to a published CMS policy document. When a claim is flagged, you see the exact rule, the plain-English explanation, and the source link — not a black-box score.
- NCCI Procedure-to-Procedure (PTP) edits
- NCCI Medically Unlikely Edits (MUE)
- Medicare Physician Fee Schedule (MPFS) indicator checks
- Local Coverage Determination (LCD) medical necessity
- ICD-10-CM diagnosis code validity
- Modifier conflict detection (25, 57, forbidden combos, ordering)
- Place of Service compatibility
- Gender and age-restricted procedure checks
- NPI structural validation
- Within-claim and cross-claim duplicate detection
- Medicare frequency limit enforcement
- Unknown / deleted procedure code detection
Rule details, source document links, and per-claim explanations are available inside the product after signup. Submit Shield does not publish its full rule catalog publicly.
Tested against real claim patterns
Catch rates measured across synthetic whitebox test suites modeled on production claim distributions. 100% specificity across all segments -- zero false positives on clean claims.
Primary Care
92.8%
Family medicine, internal medicine, pediatrics
Covers E/M bundling, modifier validation, MUE limits, and LCD medical necessity for the highest-volume claim types.
Behavioral Health
100%
Psychiatry, counseling, ABA therapy
Full coverage of time-based add-on rules, NCCI PTP edits for psychotherapy, and frequency limits on diagnostic evaluations.
DME
80%
CPAP, wheelchairs, orthotics, prosthetics
Validates HCPCS-to-ICD linkage, rental vs. purchase modifiers, and LCD coverage criteria for durable medical equipment.
Ambulance
68.2%
Ground and air transport
Checks origin/destination modifiers, mileage coding, medical necessity indicators, and condition code alignment.
Catch rates derived from synthetic whitebox testing against curated claim sets representing each specialty segment. Methodology details available on request.
Simple pricing. No per-claim fees. No surprises.
Flat monthly pricing based on claim volume. Every plan includes all 18 rules and full CMS source traceability.
Starter
Up to 5,000 claims per month
- Up to 5,000 claims per month
- 18 deterministic validation rules
- Python SDK access
- CMS source links on every flag
- Email support
Practice
Up to 25,000 claims per month
- Up to 25,000 claims per month
- 18 deterministic validation rules
- Python, Docker, and Windows SDK
- Denial-feedback dashboard
- Confusion matrix and precision/recall metrics
- Priority support
Group
Up to 100,000 claims per month
- Up to 100,000 claims per month
- 18 deterministic validation rules
- All SDK modes included
- Denial-feedback dashboard
- Confusion matrix and precision/recall metrics
- Dedicated onboarding
- Phone and email support