Invalid claim/missing info alerts

Purpose

1.1. Automate detection and notification of invalid insurance claims or missing patient/billing information for child psychiatry practices.
1.2. Reduce manual intervention by automating alerts to staff or patients upon claim errors, missing documents, or incomplete charge entries.
1.3. Enable automatable workflows across EHR, PMS, and insurance portals to minimize revenue cycle disruptions, automate compliance, and support efficient claim resolution.

Trigger Conditions

2.1. Claim submitted with missing patient details (DOB, policy number, diagnosis code).
2.2. Payer response received stating "invalid claim" or "information missing".
2.3. EHR/PMS flags required documents not attached or information fields blank.
2.4. Rejection/error status received from clearinghouse or insurance API.
2.5. Chronological rule: claim not updated within X hours/days after submission or error.

Platform Variants

3.1. Epic Systems (EHR)
• Feature/Setting: Configure Hyperspace Work Queues for "missing info" alert rule; Use Interconnect API "Patient.GetPatientInformation" for automated field checks.
3.2. Cerner Millennium
• Feature/Setting: Setup PowerChart task automation; "Cerner Open Developer Experience (code) API: Get Encounter/Claim Status" for missing info flags.
3.3. AthenaHealth
• Feature/Setting: Leverage "Claims API - GET /claims" for rejected/errored claims, automate outbound alerts using Communication API.
3.4. Allscripts
• Feature/Setting: Use "Practice Management API - GetMissingInformation" for incomplete billings, trigger tasks via Task Management module.
3.5. NextGen Healthcare
• Feature/Setting: Automate "Claim Edit Errors" via EHR Notifications API, integrate triggers with Practice Management dashboards.
3.6. Kareo
• Feature/Setting: Utilize "Insurance Claim Status API," configure event-based alerts on status "rejected" or "incomplete."
3.7. Availity
• Feature/Setting: Automate alerts from Availity "Claim Status API," custom notification hooks for error codes.
3.8. Change Healthcare
• Feature/Setting: Employ "Claim Status API v2" for rejection/error detection, support automated notifications to responsible staff.
3.9. Greenway Health
• Feature/Setting: Greenway API "Get InsuranceResponse" automated for missing/invalid info, trigger workflow alerts.
3.10. PracticeSuite
• Feature/Setting: "Invalid Claim Alert Report," automate criteria with Workflow Automator.
3.11. Salesforce Health Cloud
• Feature/Setting: Configure "Health Cloud Flows" with Health Cloud APIs ("Encounter information" and "Care Program Compliance Triggers").
3.12. Microsoft Power Automate
• Feature/Setting: Create automatable flows with "When a HTTP request is received" and "Send email notification v2".
3.13. Zapier
• Feature/Setting: Automate new “claim rejected” email or Slack alert via "Webhooks by Zapier".
3.14. Twilio SMS
• Feature/Setting: Set up automated “claim issue alert” text via Programmable SMS API; sample: POST /Messages endpoint.
3.15. SendGrid
• Feature/Setting: Automate claim status notification email using "Mail Send API"; configure template for missing details.
3.16. Slack
• Feature/Setting: Use "Incoming Webhooks" to automate channel alerts for claim errors.
3.17. PagerDuty
• Feature/Setting: Automate incident ticket creation for critical claim rejections using Events API v2.
3.18. Google Workspace (Gmail)
• Feature/Setting: Automate error notification emails using "Gmail API - Send Messages" endpoint.
3.19. Outlook/Office 365
• Feature/Setting: Automate alerts with "Outlook Graph API - SendMail" for invalid claims.
3.20. Monday.com
• Feature/Setting: Automate board item creation tagged "Claim Issue" via Monday API mutations.
3.21. JIRA Service Management
• Feature/Setting: Automate ticket creation for each invalid/missing info claim via "Create Issue" REST API.
3.22. ServiceNow
• Feature/Setting: Automate incident workflow with "Table API" to log claim errors.
3.23. Trello
• Feature/Setting: Use Trello API “Create Card” to automate board alerts for each error/rejection event.
3.24. DocuSign
• Feature/Setting: Automatically request and monitor missing signatures via "Envelopes: ListStatusChanges" API.
3.25. AWS SNS (Simple Notification Service)
• Feature/Setting: Automate push or SMS/email alerts on claim event trigger; use Publish API.
3.26. Google Sheets
• Feature/Setting: Log invalid claim rows via "Sheets API: Append" for audit/monitoring automation.

Benefits

4.1. Automates prompt alerts, reducing claim processing delays and payment turnarounds.
4.2. Automatedly streamlines error resolution for mental health billing, critical for compliance.
4.3. Supports automator-driven follow-ups at each workflow stage, increasing claim acceptance rates.
4.4. Enables auditable records for regulatory needs and simplifies manual workload by automating repetitive tasks.
4.5. Empowers staff to focus on patient care instead of claim chasing; automation ensures fewer missed reimbursements.
4.6. Mitigates risk of lost revenue via automatable and scalable notification systems spanning all communication and EHR platforms.