Claims submission automation

Purpose

1.1. Automate claims submission by receiving, validating, enriching, transmitting, tracking, and reconciling insurance claims for pain management physicians.
1.2. Automates detection of incomplete patient documentation and prompts for corrections prior to claim transmission.
1.3. Automates standardized claim file generation (X12 837), ensuring regulatory compliance.
1.4. Automates routing to the appropriate payer portals (Medicare, private insurance) for pain medicine scenarios.
1.5. Automates status tracking and automated notifications for rejections, denials, or payments.
1.6. Automatedly extracts and reconciles ERA (835) files for streamlined revenue cycle management.
1.7. Automates alerts for exceptions, underpayments, and missing follow-ups to ensure claims are not lost or delayed.

Trigger Conditions

2.1. Automates submission upon completion of encounter documentation in EHR/EMR system.
2.2. Automatedly triggers on batch schedule (e.g., end-of-day, real-time on new claims, manual override).
2.3. Automates when EOB or ERA files are posted by insurers into document management system.
2.4. Automated exception triggers for claim rejections, auto-appeal, or escalation.

Platform Variants

3.1. athenahealth
• API: "/claims" endpoint to automate new claim creation and status checks.
3.2. Epic Systems
• Interconnect API: "Claims Submission" module for automating HL7/X12 transmission.
3.3. Cerner
• Millenium API: "Financial Management – Claims" automate claim batch upload.
3.4. AdvancedMD
• Insurance Claims API: Automates electronic submission and status fetch.
3.5. Kareo
• Claim Submission API: Automate digital claims creation and transmission.
3.6. NextGen
• EHR API: "Claims Management" automates 837 creation and integration.
3.7. DrChrono
• Billing API: Automates submission and status retrieval of insurance claims.
3.8. eClinicalWorks
• "Billing API": Automated insurance claim upload and payment status.
3.9. PracticeSuite
• Claims API: Configure to automate EDI claims and ERA processing.
3.10. Office Ally
• SFTP EDI: Automates claim file drop and retrieval using SFTP integration.
3.11. Waystar
• Claims Connector API: Automates claim submission, rejection, and payment tracking.
3.12. Availity
• "Claims Submission API": Automate digital claims and real-time status queries.
3.13. Change Healthcare
• Intelligent EDI API: Automates HIPAA-compliant claims intake and routing.
3.14. Experian Health
• Eligibility & Claim Status API: Automates checking and updating claim progress.
3.15. TriZetto Provider Solutions
• EDI Gateway API: Automated digital claim creation and remittance handling.
3.16. Greenway Health
• Intergy API: Automates insurance claim workflows and reconciliation.
3.17. Allscripts
• Practice Management API: Automates claims lifecycle from submission to payment.
3.18. Meditech
• Revenue Cycle API: Automates synchronous claim uploads and payment notifications.
3.19. OpenEMR
• EDI Module: Automates claims file output generation for clearinghouse uploading.
3.20. HealthFusion MediTouch
• Billing API: Automates digital claim submission and follow-ups.

Benefits

4.1. Automates reduction in human data entry errors and ensures claim completeness at source.
4.2. Significantly automates turnaround time for reimbursements, boosting cash flow.
4.3. Automated claim tracking optimizes follow-ups and decreases missed payments.
4.4. Automator increases throughput with instant submission and batch automating.
4.5. Decreases manual workload and administrative overhead by automating complex insurance workflows.
4.6. Enhances compliance by automating updates to payer requirements and automating audit trail maintenance.
4.7. Improves patient and physician satisfaction by automating a seamless billing and insurance process.