Billing and claims submission automation

Purpose

1.1. Automate billing and claims submission to reduce admin workload for cardiovascular and thoracic surgeons.
1.2. Automatedly extract procedure, diagnosis, and patient data from EHR/EMR systems and generate compliant invoices and insurance claims.
1.3. Automate error checking, claims attachment, submission, and payer followup to accelerate reimbursement and minimize denied claims.
1.4. Automating data flow between practice management solutions, clearinghouses, insurers, and payment posting systems.
1.5. Automate batch uploads, multi-payer routing, claims reconciliation, and remittance advice import.

Trigger Conditions

2.1. Case completion documentation in EHR.
2.2. Physician signature on operative/consult note.
2.3. Patient discharge event.
2.4. New billing task assigned in PM or EMR.
2.5. Daily/weekly scheduled automation runs.
2.6. Receipt of payer remittance data or claim status update.

Platform Variants

3.1. Epic
• Function/API: Clarity/Epic Bridges for automated extraction of billing encounters and CPT/ICD codes.
3.2. Cerner
• Function: Cerner Millennium PowerChart eService APIs to automate claim file creation.
3.3. Athenahealth
• Feature: Billing API—automated generation and submission of claims.
3.4. Allscripts
• Setting: Practice Management API—automating invoice initiations and error flagging.
3.5. Meditech
• Feature: Claims Management Interface for automated batch file export.
3.6. eClinicalWorks
• API: Automated charge capture, claim export, and status checks.
3.7. NextGen
• Function: Electronic claims submission API automates insurance delivery.
3.8. DrChrono
• Setting: Automated superbill generation + claim creation triggers.
3.9. Kareo
• Feature: Automated claims submission workflow and payer rule configuration.
3.10. Greenway Health
• API: Financial Management—auto-create and send claims based on coding closure.
3.11. AdvancedMD
• Feature: Automated EDI claim generation, error reporting API.
3.12. OpenEMR
• Setting: Automated billing batch export to clearinghouse EDI format.
3.13. PracticeSuite
• API: Automated claim file generation, ERA reconciliation.
3.14. Waystar
• Function: Clearinghouse Automation—claim scrubbing and real-time status APIs.
3.15. Availity
• API: RCM automation—multi-payer submission and eligibility checks.
3.16. Change Healthcare
• Service: Medical Network APIs automate claim, remittance, and status updates.
3.17. InstaMed
• API: Auto-posting patient payments and remittance triggers.
3.18. Office Ally
• Feature: Batch claims automation and payer response reconciliation.
3.19. X12 EDI (by ANSI standards)
• Setting: 837 claim and 835 remittance automation with compliant data formatting.
3.20. Salesforce Health Cloud
• API: Automate mapping EHR encounters to invoice objects and claim submit triggers.
3.21. Zoho Creator
• Function: Custom automator for receiving EHR inputs, claim creation, and attachment workflows.
3.22. QuickBooks (Integrates via middleware)
• Feature: Automated billing entries, export, and reconciliation based on claim status.

Benefits

4.1. Automates away redundant manual data entry and errors for cardiovascular surgical practices.
4.2. Automated claim case tracking and remittance reconciliation accelerates payment cycles.
4.3. Reduces denials and administrative rework by automating coding and compliance checks.
4.4. Automating multi-platform data exchanges strengthens financial transparency and reporting.
4.5. Enables staff to focus on patient care, not paperwork, by automating end-to-end billing and claims submission tasks.