Claims submission and tracking automation

Purpose

1. Automate the submission and tracking of insurance claims for emergency care physicians to streamline billing, reduce errors, minimize manual intervention, speed up payment cycles, and maintain compliance across multiple insurers and billing formats.

2. Automating end-to-end claim lifecycles—from initial patient encounter to final payment notification—ensures timely, accurate, and efficient claim management, improving both operational efficiency and revenue integrity in an emergency medicine context.

Trigger Conditions

1. New patient discharge recorded in EHR/EMR.

2. Coding or billing team finalizes treatment and diagnosis entries.

3. EDI/X12 837 file generated for claim.

4. Rejected claim or request for additional information received.

5. Updated insurance data uploaded or payer status response posted.

Platform Variants

1. Athenahealth

• API: /claims/submit; /claims/status – Automates claim submission and status checks via REST API integration.
  

2. Cerner

• Feature: Millennium EHR API – Automatable claim data extraction and submission endpoint.
  

3. Epic Systems

• Feature: Open.epic FHIR APIs – Automator pulls billing data, automates claim pushes, and tracks responses.
  

4. AdvancedMD

• Function: Claims Scrubbing Automation – Use claims API to auto-send and track claim files.
  

5. Practice Fusion

• API: Claims Submission – Set up automator for batch claim sending and results fetching.
  

6. Kareo

• Feature: Integrated Claims – Automate the claims status checks and notifications through Kareo API.
  

7. eClinicalWorks

• Function: Claims Module API – Automator for pushing 837 files and tracking remittance advice.
  

8. Greenway Health

• Feature: API: claim.submit, claim.status – Automates standardized claim communication.
  

9. Trizetto

• EDI Gateway: Automated claims upload and remittance download using SFTP/API.
  

10. Office Ally

• Function: X12 claim processing – Automate batch claim uploads and status queries.
  

11. Availity

• Feature: API for claim submission and real-time status checking.
  

12. Change Healthcare

• API: Claims & Denials Management – Automates submitting and tracking claim workflows.
  

13. DocuSign

• Feature: Envelope API – Automate patient authorization and claim signature collection.
  

14. Salesforce Health Cloud

• API: Claims Management – Automator to create, submit and monitor claims within CRM.
  

15. Twilio

• Feature: Programmable SMS – Automatedly alert staff/patients to claim updates or issues.
  

16. SendGrid

• API: Automated notifications for claim status, rejections, and payments to staff or patients.
  

17. Google Cloud Healthcare API

• Feature: FHIR to X12 conversion and automated data routing.
  

18. AWS HealthLake

• API: Integrate FHIR data, automate claim lifecycle triggers and event-based processing.
  

19. Microsoft Power Automate

• Connector: Healthcare/EHR data triggers, automate claim file movement between apps.
  

20. Slack

• Workflow: Real-time alerts to claim updates or required manual handling via automated messaging.
  

21. Zoho Creator

• Feature: Custom forms automate claim intake, mapping to payer-specific schemas.
  

22. ServiceNow

• Integration: Automated incident creation for problematic claims or denials tracking.
  

23. SAP Healthcare

• API: Automates reconciliation between charge capture and submitted claims.
  

24. Robocorp

• Bot: Automates legacy system claim entry where APIs are unavailable.
  

Benefits

1. Automation reduces administrative workload, accelerates claim cycle times, and automates decision routing for rejections and approvals.

2. Automating status reporting improves transparency and stakeholder communication.

3. Ensures compliance with payer rules and regulatory reporting through automated error checking.

4. Automation of notification systems minimizes delays in resubmissions and patient billing steps.

5. Automating reduces financial leakage and enhances overall revenue performance for emergency medicine groups.