Billing and Compliance AutomationPurpose
1.2. Ensures swift notification to billing staff, triggers structured follow-ups, documents outcomes, and produces compliance-ready reports.
1.3. Reduces the turnaround time for recovering reimbursements and increases overall practice revenue.
1.4. Maintains audit trails for compliance and optimizes processes to prevent repeated denials.
Trigger Conditions
2.2. Direct EHR/EMR system update logging a denied claim.
2.3. Manual input by billing staff marking a claim as denied for internal tracking.
2.4. Scheduled extraction of denial data from payer portals or clearinghouses.
Platform Variants
3.1. Athenahealth
• API: Claims API – Configure webhook to send denial events.
3.2. Epic Systems
• Feature: Interconnect Web Services – Enable event notification for denial status updates.
3.3. AdvancedMD
• API: Denial Tracking Module – Schedule automated data pulls for denials.
3.4. Kareo
• API: Billing API – Push new denial notifications to workflow.
3.5. eClinicalWorks
• Feature: Remittance Manager – Set to trigger on denial codes.
3.6. Meditech
• Setting: Revenue Cycle Note Alerts – Automatically email staff on denial receipt.
3.7. Greenway Health
• Feature: Intergy Denials Worklist – Auto-assign tasks based on denial criteria.
3.8. Allscripts
• API: Payer Connectivity – Map denial messages to workflow triggers.
3.9. Cerner
• API: HealtheIntent – Enable notification for denial event streams.
3.10. NextGen Healthcare
• Setting: EDI Transaction Alerts – Automate response to remittance advice with denial indicator.
3.11. Salesforce Health Cloud
• Feature: Case Management Flow – Create denial case records on trigger.
3.12. Twilio
• Feature: SMS APIs – Notify billing teams of new denials requiring urgent attention.
3.13. Slack
• API: Incoming Webhooks – Post denial ticket updates to compliance channels.
3.14. Monday.com
• Feature: Board Automation – Create automatic tickets and assign follow-up based on claim ID.
3.15. Microsoft Power Automate
• Feature: Automated Flows – Route denial events to billing and compliance review queues.
3.16. Google Sheets
• API: Apps Script – Log every denial and resolution date to audit spreadsheet.
3.17. Zendesk
• Feature: Ticket Automation – Generate a support ticket for each denial trigger.
3.18. ServiceNow
• Feature: Workflow Designer – Standardize denial follow-up process.
3.19. DocuSign
• API: Envelope Automation – Send requests for additional documentation on denial.
3.20. SendGrid
• Feature: Transactional Email API – Send templated denial notification and escalation emails.
3.21. AWS Lambda
• Service: Event-driven scripts to process denial data and update logs.
3.22. Asana
• Feature: Task Templates – Auto-create tasks per denial category for staff assignment.
Benefits
4.2. Standardizes denial follow-up and tracking protocols for audit-readiness.
4.3. Increases financial recovery with faster denial resolution.
4.4. Improves transparency, reducing compliance risk.
4.5. Frees staff from manual tracking, increasing billing team productivity.