Billing and Compliance AutomationPurpose
1.2. Ensure all anesthesia services, modifiers, time units, and supply charges are precisely documented, coded, validated, and transmitted to billing systems and insurers.
1.3. Automate verification of procedure documentation against payer requirements to prevent denied claims and support up-to-date compliance.
Trigger Conditions
2.2. Completion of anesthesia time logs or patient encounter forms.
2.3. Detection of new or modified CPT-ASA codes, modifiers, or patient demographics.
2.4. Receipt of insurance eligibility updates or pre-authorization status.
2.5. Scheduled daily or batch export of charge data for billing teams.
2.6. Rejection/denial feedback received from payer system or clearinghouse.
Platform Variants
3.1. Epic
• API: Chronicles Data API for procedures, Hyperspace Billing API; configure triggers on anesthesia procedure documentation, auto-export to billing module.
3.2. Cerner
• Integration: MPages API, PowerChart workflow triggers; setup real-time export of anesthesia logs and time stamps.
3.3. Athenahealth
• API: Athenahealth Open APIs (“Encounter”, “Procedures”, “Charges” endpoints); auto-post encounter charges upon note sign-off.
3.4. AdvancedMD
• API: Charge Capture API, scheduler webhook; configure for immediate charge posting on encounter completion.
3.5. Meditech
• Integration: Data Export Scheduler, HL7 ADT/ORM interfaces; trigger upon completion of OR cases or anesthesia documentation.
3.6. Allscripts
• API: Practice Management API; enable event-driven charge entry based on anesthesiology note approval.
3.7. eClinicalWorks
• API: eClinicalWorks API for “Visits” and “Billing”; configure event triggers upon anesthesia record finalization.
3.8. NextGen Healthcare
• API: NextGen Office API, EPM billing module; setup anesthesia charting trigger for code generation.
3.9. Greenway Health
• API: Greenway Clinical API (“Charges” endpoint); automate charge capture from operating room event documentation.
3.10. Kareo
• API: Kareo Billing API; configure to post anesthesia charges with mapped CPT and modifiers.
3.11. Practice Fusion
• API: REST API charge entry, encounter export; set rule on anesthesia template closure.
3.12. Change Healthcare
• API: Claims Management API; integrate automated claim creation with anesthesia code parsing.
3.13. Availity
• API: Claims Submission endpoint; trigger batch claims file on anesthesia billing completion.
3.14. Waystar
• Integration: Claim Builder API; send each anesthesia encounter for real-time edit and transmit.
3.15. RelayHealth
• API: Connectivity Interface; configure HL7 outbound upon anesthesia note lock.
3.16. DocuTAP (Experity)
• API: Encounters API, Billing Rules module; link anesthesia documentation to instant charge creation.
3.17. McKesson
• API: Paragon Billing Integration endpoint; automate charge lanes based on anesthesiology service.
3.18. Office Ally
• API: EDI X12 837 file upload endpoint; export structured anesthesia charges and upload programmatically.
3.19. DrChrono
• API: /clinical_notes, /billing endpoints; post charges from anesthesia chart on lock signature event.
3.20. Salesforce Health Cloud
• API: Health Cloud Data Model; create custom automation to extract and route anesthesia charge events to partners.
3.21. Redox
• API/Integration: Redox Data Model (“Charge”, “Procedure” resources); deploy triggers on anesthesia EHR data mutation.
3.22. HL7/FHIR Services
• API: FHIR “Procedure”, “Encounter”, and “ChargeItem” resources; trigger on new anesthesia record creation.
Benefits
4.2. Shortens claim submission cycles and accelerates reimbursement.
4.3. Guarantees compliance by validating all required documentation per payer rules.
4.4. Reduces administrative burden for anesthesiologists and staff.
4.5. Enables audit trails and transparent logging for all captured charges.
4.6. Supports scalability for multi-hospital anesthesia groups.
4.7. Easily adapts to evolving compliance, billing, and payer requirements.
4.8. Facilitates integration with data analytics and denial management tools.