EOB (Explanation of Benefit) notification delivery

Purpose

1.1. Automate the secure, timely delivery of Explanation of Benefits (EOB) notification emails, SMS, or app alerts to patients and billing departments after claims are adjudicated in alcoholism treatment programs.
1.2. Ensure compliance with healthcare privacy standards (e.g., HIPAA), minimize manual communication, and provide immediate transparency on insurance claim outcomes for addiction recovery services.
1.3. Support audit and compliance tracking by maintaining logs and receipts of each notification event.

Trigger Conditions

2.1. Insurance claim status updated to “adjudicated,” “processed,” or status indicating EOB ready.
2.2. Patient discharge or treatment session completion triggers billing cycle.
2.3. Receipt of EOB file from payer or third-party administrator via SFTP, webhook, or EDI feed.
2.4. Scheduled batch notification post claims-processing daily/weekly.

Platform Variants

3.1. Twilio SMS
• Feature: Programmable Messaging API
• Setting: Configure to deliver EOB text with masked PHI; sample endpoint: `POST /Messages`
3.2. SendGrid
• Feature: Transactional Email API
• Setting: Use dynamic templates for EOB emails; API call: `POST /mail/send`
3.3. Amazon SES
• Feature: Email Sending API
• Setting: Set dedicated templates for EOB subject lines and secure delivery
3.4. DocuSign
• Feature: Envelope Sending API
• Setting: Automate signed document delivery as needed for EOB attachments
3.5. Slack
• Feature: Incoming Webhooks
• Setting: Route EOB notifications to compliance or billing channel
3.6. Microsoft Teams
• Feature: Connector API
• Setting: Send EOB mentions to defined billing channel
3.7. Zapier
• Feature: Webhooks by Zapier
• Setting: Trigger multi-channel EOB notifications from webhook event
3.8. Google Workspace (Gmail)
• Feature: Apps Script
• Setting: Auto-email script for EOB PDF attachment to patient
3.9. Outlook 365
• Feature: Microsoft Graph API
• Setting: Compose and send EOB notifications as calendar or mail items
3.10. DocuWare
• Feature: Workflow Automation
• Setting: Launch EOB notification cascade upon document storage event
3.11. Salesforce Health Cloud
• Feature: Process Builder
• Setting: Trigger templated EOB emails after record update
3.12. Intercom
• Feature: Message API
• Setting: Deliver EOB status messages via chat/account updates
3.13. Mailgun
• Feature: Email Sending API
• Setting: Route EOB notification using campaign/transactional sending
3.14. WhatsApp Business API
• Feature: Message Templates
• Setting: Pre-approve and configure EOB notification templates
3.15. RingCentral
• Feature: SMS API
• Setting: Direct EOB alert as SMS to patient or admin staff
3.16. PagerDuty
• Feature: Events API
• Setting: Notify compliance/billing on EOB delivery failure
3.17. QuickBase
• Feature: Pipelines
• Setting: Auto-trigger EOB notification when 'EOB received' field updates
3.18. Smartsheet
• Feature: Automated Workflows
• Setting: Send customized EOB emails upon row change in billing tracker
3.19. HubSpot
• Feature: Workflow Automation
• Setting: Trigger EOB email/SMS sequences on claim completion
3.20. ServiceNow
• Feature: Flow Designer
• Setting: Generate tasks or notifications for each EOB delivery step
3.21. Box
• Feature: Webhook Triggers
• Setting: Trigger EOB notifications when EOB PDF uploaded to specific folder
3.22. OneSignal
• Feature: Push Notification API
• Setting: Send EOB status push alert to patient mobile app
3.23. Plivo
• Feature: SMS API
• Setting: Deliver EOB summary via automated SMS with log
3.24. Slack
• Feature: Bot messaging API
• Setting: Automate staff notification for high-value EOBs

Benefits

4.1. Reduces administrative burden by eliminating manual notification.
4.2. Ensures timely disclosure per compliance guidelines.
4.3. Improves patient and provider satisfaction with near-instant communication.
4.4. Enables secure, audited delivery reducing risk of missed notifications.
4.5. Scalable to all volume levels, adjusting to fluctuating claim loads.