Tracking denial and approval status alerts

Purpose

1. Automate monitoring of claim submission responses to automatically detect, track, and notify staff of insurance claim denials or approvals for orthotics & prosthetics services.

2. Automate alerts for time-sensitive actions, escalating denials for rapid resolution and improving revenue cycle efficiency.

3. Reduce risk of lost revenue and payment delays by automating timely intervention and case management.

4. Enable automated reporting and analytics for recurring denial reasons to drive process improvements and payer negotiations.

Trigger Conditions

1. Automator is triggered when billing software receives an electronic response (835/277, or EDI file) indicating claim status change.

2. Automates when payer’s portal/API updates the claim’s approval or denial status.

3. Schedules automated polling of status endpoints or inboxes.

4. Initiates upon status change detected via webhook/event from RCM or EHR platforms.

Platform Variants

1. Salesforce Health Cloud

• API/Event: Configure Flow Builder for automated status change alerts via EHR or RCM integrations.
  

2. Epic EHR

• Feature: Use Interconnect API to automate pulling updated claim status; configure automated SmartTools to message billing teams.
  

3. Cerner Millennium

• API/Event: Use FHIR APIs for automated polling of Encounter/Claim resources and trigger automated alert tasks.
  

4. athenahealth

• Feature: Automate claim status webhook subscriptions to trigger email/SMS alerts.
  

5. Allscripts (Veradigm)

• API: Automate use of Open API “GetClaimStatus” for automated near real-time claim event notifications.
  

6. NextGen Healthcare

• Integration: Schedule automated claim status polling and trigger automated tasks or email using NextGen Connect messaging.
  

7. Waystar

• API: Automate scheduled queries using “Claim Status” API; configure automated notification email template.
  

8. Availity Essentials

• Function: Automates notification setup for approval/denial events using Availity API webhooks.
  

9. Medisoft

• Setting: Use automated claim report export and monitor for denial/approval codes, auto-notifying users.
  

10. Change Healthcare

• API: Configure “Claim Status” (276/277 EDI) API for event automation and alerts.
  

11. Greenway Health

• Integration: Automate status workflow in Intergy; trigger tasks on approval/denial updates.
  

12. Kareo

• API: Automated status checks via “Get Claim Status”; set automator to trigger SMS or in-app alert.
  

13. eClinicalWorks

• Feature: Use automated Mirth Connect integrations to monitor status flags and auto-trigger task/email.
  

14. Microsoft Power Automate

• Connector: Configure EDI trigger to detect status change in claims and automates notification via Teams/Outlook.
  

15. Zapier

• Trigger: Connect payer inbox/API to set up automated email/SMS alert or database update.
  

16. Twilio SMS

• API: Use programmable SMS to send auto-alerts when approva/denial detected in status reports.
  

17. Slack

• Bot: Automate posting notifications to designated denial/approval channel via webhook.
  

18. SendGrid

• API: Automatedly send email notifications to billing teams upon status change event.
  

19. Google Workspace

• Script: Automate status monitoring with Apps Script for Sheets/Forms and auto-send updated alerts to stakeholders.
  

20. AWS Lambda

• Function: Automates event-driven claim response processing; triggers email/SMS via SES/SNS.
  

21. Smartsheet

• Workflow: Automates updating rows/status and generating alert emails/SMS when claim status is updated.
  

22. Monday.com

• Automation: Use automated status triggers to notify users and create approval/denial cases/tasks.
  

23. HubSpot

• Workflow: Automate creation of tickets/alerts when insurance claim changes status via API/webhook.
  

24. Pipedrive

• Automation: Use deal stage automation to update status and send internal alerts upon claim events.
  

25. ServiceNow

• Workflow: Automates ticket creation and notification on event received from billing/insurance systems.
  

Benefits

1. Automates reduction of manual monitoring effort and error-prone tracking.

2. Enables rapid, automated rework of denials, boosting cash flow and revenue cycle velocity.

3. Provides auditable, automated logs and analytics for compliance and managerial review.

4. Automatedly enhances claim follow-up workflow consistency and accountability.

5. Supports scalable automation across multiple payers, reducing administrative burden.