Flagging denied or delayed insurance claims

Purpose

 1.1. Automate the detection and flagging of denied or delayed insurance claims for neurology clinics, streamlining dispute resolution and accelerating payment cycles.
 1.2. Automates notifications to financial/admin staff to review, correct, or escalate claim denials or delays, minimizing revenue loss and administrative burden.
 1.3. Supports compliance needs by automatedly generating audit trails and documentation for denied and delayed claims.

Trigger Conditions

 2.1. Automatedly triggers when insurance claims’ statuses update to “Denied,” “Rejected,” or remain “Pending”/“In Process” after a set timeframe (e.g., 14 days).
 2.2. Automates flagging based on custom rules (payer, claim type, patient category, claim amount).
 2.3. Initiated on claim status changes in billing/EMR/EHR systems or manual admin input.

Platform Variants

 3.1. Epic
  • Function/API: Claim Status Web Services — configure webhook to send claim status changes for automation.
 3.2. Athenahealth
  • Function: Marketplace API (Claims resources) — automate retrieval of claim status; webhook triggers on denied status.
 3.3. Cerner
  • Feature: FHIR Claim API — automate polling on claimStatus for denials or delays.
 3.4. eClinicalWorks
  • Feature: Interoperability API (Claims module) — automate extraction and flagging.
 3.5. Allscripts
  • Feature: Claims Management API — set up automated triggers for denied/delayed claims.
 3.6. DrChrono
  • Function: Claims API (List Claims) — automate scan for status + webhook to notify.
 3.7. Kareo
  • Feature: Claims API (Event notifications) — automate inbound alerts for denial events.
 3.8. PracticeSuite
  • Feature: Claims Adjustment Webhook — configure automation on status updates.
 3.9. NextGen Healthcare
  • Feature: Patient Financial API — automate claim status rule checks.
 3.10. Greenway Health
  • Function: Real-Time Claim Status API — automate denials checks.
 3.11. Availity
  • Feature: Denial Management API — automate flagging of remittance data.
 3.12. Office Ally
  • Feature: Claim-Follow-up API — automate regular scans for unresolved claims.
 3.13. Meditech
  • Function: Claims Status FHIR API — automate status polling/notifications.
 3.14. X12 EDI Gateway
  • Feature: 277 Claim Status Inquiry — automate importing responses, trigger on “Denied”.
 3.15. Salesforce Health Cloud
  • Feature: Claims Object — automate process builder flow for denials/delays.
 3.16. Microsoft Power Automate
  • Feature: Automated flows — connect EHR and flag in SharePoint/Outlook/Teams.
 3.17. Zapier
  • Feature: Webhooks and Email Parser — automate flagging via claim status emails.
 3.18. Slack
  • Feature: Workflow automation — receive flagged claim notifications.
 3.19. ServiceNow
  • Feature: Flow Designer — automate task assignment for denied/delayed claims.
 3.20. Google Sheets
  • Function: App Script Automation — auto-flagging cells and sending alerts.
 3.21. AWS Lambda
  • Feature: Scheduled jobs — automate querying claim status and posting results.
 3.22. Twilio
  • Feature: Programmable SMS — automate notifications to staff for flagged claims.

Benefits

 4.1. Enhance revenue cycle by automating dispute and follow-up processes on insurance denials.
 4.2. Reduces manual monitoring and administrative audit time with automation.
 4.3. Help compliance by automated trail creation for financial documentation.
 4.4. Mitigates risks of delayed reimbursement by automatically notifying relevant staff.
 4.5. Increases operational efficiency and optimizes resource allocation with automated workflows.