Billing & Claims ProcessingPurpose
1.2. Ensure compliance with healthcare, insurance, and privacy regulations (e.g., HIPAA), minimize manual errors, reduce processing time, and improve access to care for financially burdened individuals.
1.3. Integrate patient-facing digital interfaces, EHR/EMR data exchange, insurer portal access, and backend claim generation into a unified, secure automation.
Trigger Conditions
2.2. Referral from internal staff or external provider system triggers new application.
2.3. Scheduled intake event for new or recurring cohorts initiates bulk application processing.
2.4. Document upload or new insurance verification result triggers review workflow.
2.5. Deadline approaches for claims submission, triggering auto-progress or escalation in pending cases.
Platform Variants
• Feature/Setting: Embedded Signing; configure webhook for “Envelope Completed” event to capture completed applications.
3.2. HelloSign
• Feature/Setting: Signature Request API; trigger callback on “signature_request_signed” to advance status.
3.3. Formstack
• Feature/Setting: Form Submission endpoint; capture and parse new applications via REST API.
3.4. Jotform
• Feature/Setting: Webhook integration for real-time new submission event; prefill patient data.
3.5. Typeform
• Feature/Setting: Connect webhook to “form_response”; parse financial data inputs.
3.6. Salesforce Health Cloud
• Feature/Setting: Flow Builder and REST API; trigger Case creation from completed application.
3.7. Microsoft Dynamics 365
• Feature/Setting: Power Automate “When a record is created”; link to application entity.
3.8. athenahealth
• Feature/Setting: Patients API - intake POST; pull in verification results.
3.9. Epic
• Feature/Setting: FHIR API - DocumentReference; push completed financial assessment forms.
3.10. Cerner
• Feature/Setting: FHIR API - CommunicationRequest; initiate patient follow-up for missing docs.
3.11. Twilio SMS
• Feature/Setting: Messaging API; send SMS reminders for incomplete steps or approvals.
3.12. SendGrid
• Feature/Setting: Transactional mail API; email outcome/status updates to applicants.
3.13. Slack
• Feature/Setting: Incoming Webhook/Workflow Builder to alert back-office when manual review needed.
3.14. Google Workspace
• Feature/Setting: Google Sheets API to log application status; Google Drive API to store uploads.
3.15. Box
• Feature/Setting: Upload File API and Webhook for file receipt event.
3.16. OneDrive
• Feature/Setting: Graph API file-create webhook for document uploads.
3.17. QuickBooks Online
• Feature/Setting: Create invoice API for posting approved claims into AR workflow.
3.18. Xero
• Feature/Setting: Create Claims Draft via API; attach patient approval docs.
3.19. Stripe
• Feature/Setting: Customer Portal API for requesting payment plan set-up if partial aid is granted.
3.20. PayPal
• Feature/Setting: Payouts API for disbursing refunds if application is overpaid or closed.
3.21. Trello
• Feature/Setting: Card creation and movement via API for visual pipeline of application status.
3.22. Zendesk
• Feature/Setting: Ticket API for support queries/appeals linked to applications.
3.23. Docparser
• Feature/Setting: Document Parsing Rules for extracting data from uploaded docs for verification steps.
3.24. AWS Textract
• Feature/Setting: Text extraction API for ID or insurance card validation from images.
3.25. Zapier Webhooks
• Feature/Setting: Receive and POST events to stitch between legacy platforms.
Benefits
4.2. Lowers risk of manual entry errors, enhancing compliance and audit trail.
4.3. Reduces staff workload via automated document handling, review notifications, and eligibility checks.
4.4. Integrates with core billing systems, enabling real-time claims generation and reconciliation.
4.5. Improves patient satisfaction by providing real-time status updates and secure, digital experiences.