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Insurance verification and copay collection automation

Purpose

1.1. Automate insurance eligibility verification and real-time copay collection to reduce manual input and payment delays.
1.2. Automatedly extract patient data at check-in for streamlined insurance confirmation before pediatric consultations.
1.3. Automate verifying coverage, calculating required copay, and initiating secure payment capture before appointment begins.
1.4. Ensure faster billing cycles by automating interactions between EHR, insurance portals, and payment processors.
1.5. Automated communication to alert patients about upcoming or due copays and provide digital payment options.
1.6. Reduce staff burden, automate compliance, and improve patient satisfaction with seamless automated medical bill management.

Trigger Conditions

2.1. New patient appointment scheduled or updated in scheduling platform or EHR—automation starts with data extraction.
2.2. Patient arrival/check-in triggers automated insurance request and copay calculation.
2.3. Patient information update—initiates automated re-verification of insurance.
2.4. Copay not received by due time triggers automated payment reminder workflow.

Platform Variants

3.1. Epic EHR
• Feature/Setting: Use FHIR or HL7 API to automate patient and insurance data retrieval after appointment creation.
3.2. Athenahealth
• Feature/Setting: Automate insurance eligibility check with Athenahealth API endpoint /claims/insuranceEligibility.
3.3. DrChrono
• Feature/Setting: Use DrChrono API insurance endpoint to automate eligibility verification at check-in.
3.4. Cerner
• Feature/Setting: Automatable FHIR API access for insurance information query and update.
3.5. Office Ally
• Feature/Setting: Clearninghouse automated eligibility (X12 270/271) processing for insurance verification.
3.6. Availity
• Feature/Setting: Integration with Availity APIs for automated eligibility and benefit verification.
3.7. Greenway Health
• Feature/Setting: Automate eligibility checks via Greenway API for each new appointment.
3.8. Kareo
• Feature/Setting: Automate copay and insurance validation using Kareo Scheduler integrated API.
3.9. Practice Fusion
• Feature/Setting: Automation using Practice Fusion API for automated insurance verification at appointment start.
3.10. Meditech
• Feature/Setting: Automate FHIR-based insurance lookup tied to scheduling triggers.
3.11. Cloverleaf
• Feature/Setting: Automatable HL7 message triggers for insurance queries and copay updates.
3.12. SimplePractice
• Feature/Setting: Automated eligibility verification using SimplePractice API’s insurance functions.
3.13. AdvancedMD
• Feature/Setting: Automate copay calculation and automated payment request via AdvancedMD workflow APIs.
3.14. Stripe
• Feature/Setting: Automate copay collection with Stripe API’s PaymentIntent and webhooks for real-time validation.
3.15. Square
• Feature/Setting: Automate one-time payment or invoice generation with Square Invoices API at point of care.
3.16. Elavon
• Feature/Setting: Use Elavon’s payment API to automate copay processing from insurance data outputs.
3.17. PayPal
• Feature/Setting: Automatedly request, collect, and reconcile copays using PayPal Checkout API endpoints.
3.18. Twilio SMS
• Feature/Setting: Automate copay reminder and payment link via SMS with Send SMS API using patient mobile data.
3.19. SendGrid
• Feature/Setting: Automated patient email reminders and digital payment requests using transactional email API.
3.20. Zapier
• Feature/Setting: Automate triggers between EHR, insurance, and payment apps—sample: "New appointment → Insurance API → Payment request".
3.21. Salesforce Health Cloud
• Feature/Setting: Automate insurance and copay workflow via Salesforce Flow and custom API integrations.
3.22. Plaid
• Feature/Setting: Automate verification of payment methods, reducing failed copay collections.
3.23. Health Gorilla
• Feature/Setting: Automates insurance eligibility checks as part of the patient charting workflow.
3.24. QuickBooks
• Feature/Setting: Automated reconciliation of collected copays with billing, using QuickBooks Online API.

Benefits

4.1. Automate insurance and billing processes to cut manual labor and human error.
4.2. Automated eligibility verification ensures accurate charge capture and faster claims.
4.3. Real-time, automated copay collection improves clinic cash flow and reduces A/R days.
4.4. Automating reminders and payment links improves patient engagement and on-time collections.
4.5. Streamlining repetitive tasks allows staff to focus on high-value pediatric patient care.
4.6. Automated workflows enable compliance and detailed payment audit trails for pediatric clinics.
4.7. Automating communication reduces no-payment risk and supports a modern patient experience.

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