Automated insurance verification before appointments

Purpose

 1.1. To automate the verification of insurance coverage before patient appointments, reducing manual effort and ensuring eligibility.
 1.2. Automates retrieval of policy status, pre-authorizations, and out-of-pocket estimates, making the billing workflow efficient.
 1.3. Automating insurance checks ensures appointment confirmation only when valid coverage exists, minimizing denied claims and improving patient experience.
 1.4. Automator prepares instant notifications on verification status to patients and staff, automatedly triggering follow-ups if issues arise.

Trigger Conditions

 2.1. New appointment is scheduled or rescheduled in the patient management system.
 2.2. Patient uploads or updates insurance details via portal or intake forms.
 2.3. Recurring verification prior to each visit for ongoing counseling sessions.

Platform Variants

 3.1. Salesforce Health Cloud
  • Feature: "Insurance Verification" flow; set up automated triggers on appointment creation in Lightning Flow Builder.
  • Sample: Configure "Get Coverage Eligibility" action in Process Builder.

 3.2. Epic EHR
  • API: "RTE (Real-Time Eligibility)" integration; automated scheduling rule upon new patient event.
  • Sample: Add RTE workflow to appointment prep protocol.

 3.3. Cerner Millennium
  • API: "Eligibility Service" with HL7 FHIR triggers; automates insurance check on encounter creation.
  • Sample: Configure "Patient Insurance Verification" automator in Cerner Command Language.

 3.4. Athenahealth
  • API: "Insurance Eligibility" endpoint; automate verification sync at appointment add/update.
  • Sample: Webhook on appointment event triggers eligibility call.

 3.5. DrChrono
  • API: "Insurance Verification" REST; triggers on appointment booked.
  • Sample: Set automator to poll insurance info at event.

 3.6. SimplePractice
  • Feature: Integrated insurance eligibility automation.
  • Sample: Toggle automated "Eligibility Verification" in settings.

 3.7. Kareo
  • API: "Eligibility Check" function; automates at patient intake.
  • Sample: Enable eligibility automation in workflow setup.

 3.8. Office Ally
  • API: "Eligibility Request" (X12 270/271); send patient info post-appointment scheduling.
  • Sample: Schedule automatable X12 API pull on new appointment.

 3.9. Availity
  • API: "Eligibility and Benefits" automated intake; triggers upon patient creation/update.
  • Sample: Set automator to fetch patient coverage nightly.

 3.10. Practice Fusion
  • API: "Insurance Eligibility Service"; automates check in real time.
  • Sample: Enable auto-verification for new appointment slots.

 3.11. Zendesk
  • Feature: Custom trigger with insurance verification API; automate notifications with workflow builder.
  • Sample: Create webhook automator to invoke API on ticket update.

 3.12. Microsoft Power Automate
  • Connector: EHR/insurance API; automates calls based on patient or appointment triggers.
  • Sample: Build flow automating HTTP call to insurance check endpoint.

 3.13. Zapier
  • Function: Integrate EHR scheduling event to send HTTP request to insurance API.
  • Sample: Automate insurance check on new Google Calendar event.

 3.14. MuleSoft
  • Connector: Healthcare Toolkit; automates data mapping for eligibility verification.
  • Sample: Design API automator for FHIR-based insurance endpoints.

 3.15. Medisoft
  • API: Built-in eligibility verification; automate check on appointment booking.
  • Sample: Turn on automated eligibility polling in configuration.

 3.16. Adobe Sign
  • Feature: Automated workflow for signed insurance intake forms; export to verification API.
  • Sample: Configure automator to forward signed forms for instant eligibility check.

 3.17. Google Cloud Healthcare API
  • API: FHIR resources; automate verification when records update.
  • Sample: Create trigger on "Patient" resource change to invoke insurance eligibility API.

 3.18. AWS Lambda
  • Function: Serverless automation for scheduled or event-driven insurance verification jobs.
  • Sample: Build Lambda function triggered by appointment booking webhook.

 3.19. Intergy
  • API: Insurance eligibility check integrated; automates on patient registration events.
  • Sample: Configure automator for daily batch eligibility.

 3.20. Greenway Health
  • API: Automated eligibility requests within appointment workflows.
  • Sample: Point-and-click enablement of real-time insurance checking.

Benefits

 4.1. Automates pre-visit insurance workflows, minimizing claim rejections.
 4.2. Automator saves staff time, reducing administrative costs.
 4.3. Automated notifications drive proactive issue resolution and patient satisfaction.
 4.4. Automating pre-authorization steps expedites billing and payment cycles.
 4.5. Automation ensures regulatory compliance and data accuracy for healthcare providers.