Back-office, Billing, and Operational AutomationsPurpose
1.2. Ensure claims are accurately generated, securely transmitted to insurers, and real-time status updates are received and logged.
1.3. Expedite patient billing cycles, reducing manual data entry errors and streamlining insurance coordination.
Trigger Conditions
2.2. Submission of a billing entry or invoice requiring insurance claim generation.
2.3. Status update notifications from insurer portals (received via webhook, secure email, or SFTP).
Platform Variants
• Feature: API submission endpoint for claim creation.
• Sample: Configure POST to /claims/v1/submit with billing record payload.
3.2. Therabill
• Feature: Claims API with integration webhooks.
• Sample: Enable “SendToPayer” API when new invoice marked as complete.
3.3. Kareo
• Feature: Client credentials for REST API insurance claims.
• Sample: Trigger POST /services/claims/create upon visit finalization.
3.4. Office Ally
• Feature: SFTP Upload or API for electronic claims.
• Sample: Transfer standardized 837 file to specified SFTP endpoint.
3.5. SimplePractice
• Feature: Insurance claims push endpoint.
• Sample: Activate webhook to fire on “superbill ready” event.
3.6. ChiroTouch
• Feature: Claim submission module and status polling API.
• Sample: Configure recurring GET /api/claim/status by claim ID.
3.7. Athenahealth
• Feature: API suite for billing and claim status.
• Sample: POST to /claims for submission; GET /claims/status using claim identifier.
3.8. Availity
• Feature: Real-time eligibility and EDI claims API.
• Sample: Enable EDI X12 837 claim POST to Availity API endpoint.
3.9. Claim.MD
• Feature: REST API for direct claim creation & status webhooks.
• Sample: POST to /v2/claims on session close; listen for status webhook.
3.10. PracticeSuite
• Feature: Automated claim batching and submission endpoint.
• Sample: Schedule batch POST of claims to /restful/claims.
3.11. DrChrono
• Feature: EHR-integrated billing API.
• Sample: POST treatment record to /claims/submit; poll /claims/status.
3.12. NextGen Healthcare
• Feature: Real-time claim transmission API.
• Sample: Connect /api/claims/submit for each finalized visit.
3.13. Greenway Health
• Feature: EDI submission and response parser integration.
• Sample: Enable X12 837 claim outbound; parse X12 277 responses.
3.14. eClinicalWorks
• Feature: Claims web service.
• Sample: POST billing record data to /Services/InsuranceClaim.svc.
3.15. CollaborateMD
• Feature: Claims and clearinghouse API.
• Sample: Trigger claim file creation and automatic push via API.
3.16. Medisoft
• Feature: Automated 837 EDI export module.
• Sample: Auto-generate and SFTP upload upon patient checkout event.
3.17. Waystar
• Feature: Real-time claim updates with REST API.
• Sample: POST claim files and register for webhook status updates.
3.18. AxiaMed
• Feature: Healthcare payment and claims interface.
• Sample: Link EMR and auto-route claims using their secure API.
3.19. Trizetto
• Feature: Provider portal API for batch claim submissions.
• Sample: Schedule nightly batch transmission with SFTP.
3.20. HealthFusion MediTouch
• Feature: API for electronic superbill to claim conversion.
• Sample: POST completed superbill to /claims/api/submit.
Benefits
4.2. Lowers risk of administrative errors for acupuncture billing.
4.3. Enables real-time claim tracking and automated alerts for denials or approvals.
4.4. Frees staff to focus on patient care, accelerating cash flow and financial reporting.
4.5. Strengthens compliance with payer rules and enhances HIPAA data security.