Insurance claim submission upon treatment completion

Purpose

 1.1. Automate insurance claim submissions immediately after a patient's alcoholism treatment program session is completed.
 1.2. Eliminate manual claim entry for faster processing and reduced errors.
 1.3. Integrate Electronic Health Records (EHR), scheduling, and billing systems to trigger claim workflows in real time.
 1.4. Ensure compliance with insurance carrier requirements and streamline coordination with payers.

Trigger Conditions

 2.1. Treatment session marked as completed in EHR or scheduling software.
 2.2. All required clinical documentation uploaded and patient discharge status updated.
 2.3. Eligibility verified and payer details confirmed.
 2.4. Claim form fields auto-populated according to payer template.

Platform Variants

 3.1. Epic Systems
  • Feature: "After Visit Summary" webhook; configure EHR event to trigger claim API call.
 3.2. Cerner
  • Feature: HL7/FHIR interface for treatment-end event; use FHIR API to extract session completion.
 3.3. Athenahealth
  • Feature: Appointment completion webhook; setup automated POST to claim submission API.
 3.4. Kareo
  • Feature: Billing API; configure "new encounter completed" trigger for claims.create endpoint.
 3.5. AdvancedMD
  • Feature: Encounter API "Complete" status; auto-launch claimSubmit function post-session.
 3.6. Meditech
  • Feature: NPR Report trigger; auto-run claim export and upload securely to payer.
 3.7. Salesforce Health Cloud
  • Feature: Custom object trigger (Apex Flow); mapped to outbound insurance claim integration.
 3.8. DrChrono
  • Feature: Custom clinical note completion trigger; call claim submission API endpoint.
 3.9. Greenway Health
  • Feature: EHR automation rules; session-completed triggers EDI 837 claim generation.
 3.10. OpenEMR
  • Feature: "Encounter closed" action; configure claim.submit API invocation.
 3.11. SimplePractice
  • Feature: Secure webhook on appointment complete; forward to X12 claim API.
 3.12. eClinicalWorks
  • Feature: Progress Note completion event; triggers EDI/batch claim interface upload.
 3.13. Therabill
  • Feature: Post-discharge automation settings; map to claim file generator endpoint.
 3.14. Availity
  • Feature: Claims API `/claim/submit`; configure external call upon session finalization.
 3.15. Change Healthcare
  • Feature: Intelligent Healthcare Network API; use `/claims:submit` for automated processing.
 3.16. Optum
  • Feature: Claim Connect API trigger; calls submission endpoint on EHR completion.
 3.17. Waystar
  • Feature: Fetch EHR-triggered claim data; use API endpoint for batch submission.
 3.18. Google Cloud Healthcare API
  • Feature: FHIR event listener; post-encounter calls Cloud Function for EDI generation.
 3.19. AWS HealthLake
  • Feature: Lambda trigger on FHIR resource update; submits structured claim.
 3.20. Zapier
  • Feature: Multi-step workflow; EHR webhook triggers outgoing claim to integrated platform.
 3.21. Intersystems Ensemble
  • Feature: HL7 interface trigger; auto-submit generated claim message.
 3.22. Redox
  • Feature: Event notification on discharge; invokes claim.submit Redox API.

Benefits

 4.1. Faster claim submission ensures quicker revenue cycle.
 4.2. Minimizes human entry errors and reduces rejected claims.
 4.3. Cut down administrative overhead and intervention.
 4.4. Enhances patient service with prompt insurance handling.
 4.5. Maintains compliance by automating payer-specific requirements.