Automatic claim submission to insurance providers

Purpose

1.1. Automate the submission of anesthesiology billing claims to insurance providers, reducing manual labor, ensuring faster reimbursements, minimizing human error, maintaining regulatory compliance, tracking claim status, automating attachments/forms, and integrating claim data from EHR/EMR systems.

Trigger Conditions

2.1. Completion of anesthesia service documented in EHR/EMR.
2.2. Finalization of patient encounter notes.
2.3. Signed-off billing review in management system.
2.4. Escalation for recurring incomplete claims.
2.5. Scheduled batch triggers (e.g., daily at 7 pm).

Platform variants

3.1. Epic EHR
• Feature/Setting: Post-encounter integration via Epic App Orchard API. Configure automated extract from patient visit summary, with real-time webhook push to claim builder API.
3.2. Athenahealth
• Feature/Setting: Use Claims API; set webhook event for finalized encounters, auto-generate and submit insurance claims in JSON format.
3.3. Cerner
• Feature/Setting: FHIR Claim resource automation; use scheduled extract-and-send based on encounter completion.
3.4. AdvancedMD
• Feature/Setting: Claim Submission API; configure event trigger on chart completion for direct submission to insurance.
3.5. Kareo
• Feature/Setting: API endpoint for claim batch submission; schedule nightly exports integrated via secure REST call.
3.6. NextGen Healthcare
• Feature/Setting: Claims Management API, trigger on completed procedure notes marked by anesthesiologist.
3.7. DrChrono
• Feature/Setting: Billing API, webhook on appointment status = complete, auto-fill claim data and submit.
3.8. Allscripts (now Veradigm)
• Feature/Setting: Connect via Practice Management API, push claims as soon as encounter is signed off.
3.9. Greenway Health
• Feature/Setting: Prime Suite API auto-triggers, claims generated and filed per provider settings.
3.10. Meditech
• Feature/Setting: MEDITECH API trigger on coding complete, format HL7 or FHIR claim for insurer.
3.11. Availity
• Feature/Setting: Direct Data Entry (DDE) and Real-Time API; integrate claim data submission after billing review.
3.12. Change Healthcare
• Feature/Setting: Medical Network Claims API; automate EDI 837P transactions after EHR export.
3.13. Waystar
• Feature/Setting: Claim Submission API, configure batching after anesthesia schedule closure.
3.14. Office Ally
• Feature/Setting: SOAP API endpoint "SubmitClaim", triggered by EMR status change.
3.15. Practice Fusion
• Feature/Setting: RESTful Billing API; triggers on patient discharge.
3.16. OpenEMR
• Feature/Setting: Custom webhook integration, export claim XML after CPT/ICD coding.
3.17. eClinicalWorks
• Feature/Setting: eBO API extract of finalized encounters, auto-send as claim file.
3.18. Medisys
• Feature/Setting: ClaimConnect API, configure submission at chart completion event.
3.19. SimplePractice
• Feature/Setting: Electronic Claim Submission API, scheduled submission for completed notes.
3.20. Surescripts
• Feature/Setting: Claim submission transaction API, fires after service documentation.

Benefits

4.1. Eliminates manual errors in claim entry and data transcription.
4.2. Accelerates insurance payment cycles and reduces payment delays.
4.3. Increases staff productivity by automating repeatable claim processes.
4.4. Ensures up-to-date compliance with insurance billing requirements.
4.5. Enables tracking and proactive management of claim rejections/denials.
4.6. Frees up anesthesiologist and billing team for value-added tasks.
4.7. Enhances financial predictability through consistent cash flow.
4.8. Improves patient satisfaction by speeding up billing interactions.