Automated copay and patient responsibility notification

Purpose

1.1. Notify patients automatically about their copay amounts and outstanding financial responsibilities after medical procedures, enhancing transparency, accelerating collections, ensuring regulatory compliance, and reducing manual billing errors.
1.2. Integrate data from EHR and billing to deliver real-time, HIPAA-compliant notifications via patient-preferred channels (SMS, email, voice, portal) immediately upon claim adjudication or at scheduled intervals.
1.3. Enable patient engagement pre- and post-visit by prompting payment, offering explanation of charges, and supporting interactive responses (questions, payment arrangements).

Trigger Conditions

2.1. EHR/PM system logs finalized patient visit and billing codes.
2.2. Insurance adjudication result received, calculating patient copay/responsibility.
2.3. Payment not yet received within specified days.
2.4. Patient appointment scheduled or completed.
2.5. Manual trigger by billing staff for specific accounts.

Platform Variants

3.1. Twilio SMS
• Feature/Setting: Use "Programmable Messaging" API—configure webhook on claim update to send SMS with balance details; sample: POST to /Messages with patient phone and template.
3.2. SendGrid
• Feature/Setting: "Mail Send" API—configure automation to trigger upon billing item update and email template with account summary; sample: POST to /mail/send with dynamic template data.
3.3. Salesforce Health Cloud
• Feature/Setting: Process Builder or Flow—automate outbound message based on Billing Status field; configure alert with merge fields for patient details.
3.4. Epic EHR App Orchard
• Feature/Setting: "Patient Communication" API—trigger message when VisitSummaryUpdated event is received; send text/email using direct patient contact info.
3.5. Cerner Open Developer Experience
• Feature/Setting: "Patient Messaging" API—trigger when new claim is posted; include copay details; configure push notification for patient portal.
3.6. Slack
• Feature/Setting: "Incoming Webhooks"—send notification to billing channel when patient is notified, providing reference info for staff; sample: POST to /services/T000/B000/XXXX.
3.7. Microsoft Teams
• Feature/Setting: "Incoming Webhook"—ping billing teams with summary when automated patient notification is sent out for exception handling.
3.8. Stripe
• Feature/Setting: "Payment Request" API—automatically generate and email payment links embedded in notification messages.
3.9. QuickBooks Online
• Feature/Setting: "Invoice API"—flag invoice as ‘copay notified’ and update patient communication history field.
3.10. Freshdesk
• Feature/Setting: "Ticket Creation" API—generate ticket for billing questions triggered by patient responses to notifications.
3.11. ServiceNow
• Feature/Setting: "Flow Designer"—configure notification workflow to escalate cases if no patient response after notification.
3.12. Slackbot
• Feature/Setting: "Custom Command"—alert billing lead with patient name and notification status.
3.13. Intercom
• Feature/Setting: "Post Message" API—send in-app message or email to patient after copay calculated event.
3.14. SimpleTexting
• Feature/Setting: "Campaign API"—add patients to copay notification campaign on trigger; include payment call to action.
3.15. HubSpot
• Feature/Setting: "Workflow Automation"—create task or trigger email/SMS to contact when copay is determined.
3.16. DocuSign
• Feature/Setting: "Envelope API"—send acknowledgment or consent forms pre-populated with copay details.
3.17. Zendesk
• Feature/Setting: "Ticket Update" API—log outgoing notification under patient’s ticket for audit/compliance.
3.18. Mailchimp
• Feature/Setting: "Transactional Email" API (Mandrill)—immediately send transactional notification with balance amounts.
3.19. Google Cloud Functions
• Feature/Setting: HTTP Trigger—run logic to parse adjudication data and call notification APIs when calculation completes.
3.20. AWS SES
• Feature/Setting: "SendEmail" API—deliver secure emails containing payment due details; monitor delivery status for escalation.

Benefits

4.1. Minimizes billing staff workload by automating patient communication.
4.2. Reduces revenue cycle gaps via instant, multi-channel notifications.
4.3. Improves patient clarity and satisfaction through real-time updates.
4.4. Accelerates copay collection, improving cash flow and compliance.
4.5. Enables scalable, error-free outreach to all patient accounts.