Billing and Insurance AutomationPurpose
1.2. Automates extraction of patient, treatment, and billing data from EMRs or billing software.
1.3. Automates formatting and validation of claim data in insurance-required formats (e.g., X12 EDI 837P).
1.4. Automatedly submits claims via relevant insurance provider APIs or clearinghouses.
1.5. Automates notifications and error handling if claim rejections arise.
1.6. Automates retrieval and archiving of remittance and response files.
1.7. Enables end-to-end billing automation, reducing manual entry and claim resubmissions.
1.8. Supports audit trail automation for compliance and reconciliation.
1.9. Automates increasing first-pass claim acceptance rate via accurate data entry.
Trigger Conditions
2.2. Successful verification of insurance eligibility.
2.3. Periodic schedule (e.g., batch submit every 12 hours).
2.4. User click to initiate individual claim automation.
2.5. Updated claim status from clearinghouse/insurance response.
Platform Variants
3.1. Athenahealth
• Feature: Claims API endpoint — automate claim submission by POST/PUT to /claims.
3.2. AdvancedMD
• API: Automated EDI 837 submission via API v2.0 ClaimService.
3.3. Kareo
• Function: Claims endpoint — automate claim JSON payload to /claims/create.
3.4. DrChrono
• Endpoint: Insurance Claims API — automated POST to /insurance_claims.
3.5. NextGen Healthcare
• Option: Claim Automation through Claims Management API — /api/claims.
3.6. Office Ally
• Setup: Automated sFTP transfer of 837 files to sftp.officeally.com/inbound.
3.7. Availity
• Feature: Real-Time Claim Submission API — automate calls to /claims/submit.
3.8. Change Healthcare
• Mode: Medical Claims Management API — automatedly POST claims/837.
3.9. PracticeSuite
• API: Claims Module — automate POST submissions to /api/v1/claims.
3.10. OpenEMR
• Automation: Claims export to X12, automatedly upload via REST.
3.11. Cerner
• Service: Automated encounter data extraction and batch EDI submission.
3.12. eClinicalWorks
• Module: Automated claim batch upload through eBO Reports API.
3.13. Epic
• Interface: Interoperability API — automate claims via FHIR InsuranceClaim resource.
3.14. Meditech
• Automation: Scripted billing export for automated file transfer.
3.15. Greenway Health
• API: Marketplace Claims Automation App for POST claim files.
3.16. SimplePractice
• Feature: Insurance Claims Automated Submission, POST via secure API.
3.17. MDToolbox
• API: Direct automated submission to ClaimSend endpoint.
3.18. Eligible.io
• REST API: /claims/bill endpoint for automated claim posting.
3.19. InstaMed
• API: Automated Healthcare Payments and Claims—POST claims to /v2/claims.
3.20. Ciox Health
• Service: Automated claim data delivery through ClaimStream.
3.21. Health Gorilla
• API: Insurance Claims FHIR endpoint — automated POST for insuranceClaim.
3.22. Waystar
• Feature: Batch automated claim file uploader via SFTP API.
3.23. TriZetto Provider Solutions
• Mode: Automated 837P/X12 claim submission through Secure FTP.
Benefits
4.2. Automates reduction of manual errors and duplicate entries in medical insurance processes.
4.3. Automated claim status update feeds streamline billing department operations.
4.4. Accelerates claim adjudication and cash flow through automation.
4.5. Enables scaling of claim volumes with minimal additional staffing.
4.6. Automates compliance and audit readout creation.
4.7. Improves patient satisfaction by automating billing clarity and insurance communication.
4.8. Reduces claim resubmission rates by automating validation and corrections.
4.9. Automates custom alerts and escalations for denied claims.
4.10. Centralizes claim file management with automated archiving and retrieval.