Denied claims follow-up notifications

Purpose

 1.1. Automate tracking and notification for denied insurance claims to ensure timely follow-up by the ABA billing team.
 1.2. Reduce manual handling of claim statuses, mitigate cash flow issues, and streamline appeals or correction processes.
 1.3. Provide real-time status updates per payer, with structured escalation and documentation.
 1.4. Ensure compliance by documenting follow-up actions and maintaining audit trails.
 1.5. Notify relevant staff or supervisors based on customizable rules or thresholds (e.g., claim age, denial reason).

Trigger Conditions

 2.1. Insurance claim status updated to "Denied" in EHR, practice management, or billing system.
 2.2. Receipt of payer’s electronic ERA/EOB with denial code.
 2.3. Elapsed days since claim submission exceed a specific threshold and claim unresolved.
 2.4. New entry added to denied claims tracker (spreadsheet/CRM/API).
 2.5. Manual flag by staff for exceptional cases needing urgent review.

Platform Variants

 3.1. Salesforce Health Cloud
  • Feature: Workflow Rule/Process Builder — fire automation on status field change to “Denied”.
  • Example: "If Claim_Status__c == 'Denied', send Notification_Email() to [email protected]"

 3.2. Athenahealth API
  • Feature: Claim Events Webhook — configure webhook to notify on deny event.
  • Example: Set webhook for /claims/denied endpoint, map to claims team inbox.

 3.3. Epic App Orchard
  • Feature: Chronicles Data Feed / Interconnect API for Claim Status.
  • Example: Subscribe to DENIED_CLAIMS feed; trigger alert on field update “ClaimStatus = Denied”.

 3.4. Kareo
  • Feature: API Notification Webhooks — configure webhook on claims endpoint filter: status=Denied.
  • Example: URL endpoint for webhook, set filter “status=Denied”, select notification recipient.

 3.5. AdvancedMD
  • Feature: Custom Reports Scheduler and Email Alerts.
  • Example: Setup scheduled report "Denied Claims", auto-email billing lead weekly.

 3.6. Practice Fusion
  • Feature: Referral/Task Automation; status-triggered message.
  • Example: Task rule “If claim denied, assign follow-up task to team”.

 3.7. DrChrono API
  • Feature: Denial States via `GET /claims` API, filter for denial.
  • Example: Poll endpoint, on denial, trigger alert_action().

 3.8. Greenway Health Intergy
  • Feature: Task Assignment Automation for Billing Events.
  • Example: Auto-generate work queue/task on denial received.

 3.9. NextGen
  • Feature: Rules Engine — trigger internal message on denial code in claim record.
  • Example: “On DenialReason field update, send secure message to billing.”

 3.10. Office Ally
  • Feature: Daily Denied Claims CSV Export Schedule.
  • Example: Scheduled export pushes denied claims to email/SFTP.

 3.11. Twilio SMS
  • Feature: Programmable SMS — send text alert to claims handler.
  • Example: Trigger SMS via REST API when new denial record flagged.

 3.12. SendGrid
  • Feature: Transactional Email API — email template for denied claim follow-up.
  • Example: Trigger POST /mail/send with claim info to [email protected].

 3.13. Slack
  • Feature: Incoming Webhook — push message to #billing-alerts.
  • Example: Webhook posts "Claim # denied. Click to review."

 3.14. Microsoft Teams
  • Feature: Connector Card — automate Teams post mentioning billing group.
  • Example: Teams API sends denial detail to Billing Team channel.

 3.15. Gmail API
  • Feature: Automated filtered alerts on denial-related email or data.
  • Example: Create label "Denied" and trigger draft email to billing team.

 3.16. Outlook (Office 365)
  • Feature: Rules + Graph API for notification on denial emails.
  • Example: Rule watches for “Denied” in subject, triggers forwarding.

 3.17. Zapier
  • Feature: Multi-platform triggers for denials in integrated apps.
  • Example: If claim status changes to Denied in EHR, notify billing via Slack.

 3.18. Google Sheets API
  • Feature: Append new denial to sheet, trigger notification.
  • Example: On new “Denied” row, send email using Apps Script.

 3.19. Airtable
  • Feature: Automation of record status change to Denied, sends follow-up email.
  • Example: When Status field = Denied, trigger email notification action.

 3.20. ServiceNow
  • Feature: Business Rule for incident when denied claim record is logged.
  • Example: Rule “if status=Denied create Incident assigned to Billing Group”.

Benefits

 4.1. Prevents overlooked denials, ensuring prompt financial recourse.
 4.2. Increases operational efficiency by standardizing follow-up processes.
 4.3. Provides actionable visibility and accountability for claims.
 4.4. Reduces manual errors, improves staff productivity and morale.
 4.5. Tracks and escalates unresolved denials, improving recovery rates and compliance.