Billing, Payments & Insurance CoordinationPurpose
1.2. Streamline real-time payment collection to ensure revenue capture, prompt notifications, and comprehensive records.
1.3. Integrate insurance eligibility verification, claim status checking, and invoice dispatch.
1.4. Eliminate manual reconciliation by syncing with EHR, finance, and reporting systems for compliance and audit readiness.
Trigger Conditions
2.2. Insurance eligibility verified or updated for the session.
2.3. Claim processed or update received from payer.
2.4. Manual override or patient request for payment record update.
2.5. Scheduled batch billing cycle initiation.
Platform Variants
• Feature/Setting: Real-time insurance verification, claim scrubbing, charge import.
• Sample: Configure webhook on "New Charge" event, call "Get Co-Pay".
3.2. AdvancedMD (Patient Payments API)
• Feature/Setting: Patient payment profile creation, charge posting.
• Sample: Use "POST /payments" with co-pay value.
3.3. Stripe (Payments API)
• Feature/Setting: Automate payment requests, recurring billing.
• Sample: Configure webhook on invoice; call "/payment_intents".
3.4. Square (Checkout API)
• Feature/Setting: Dynamic payment link generation for co-pays.
• Sample: "CreatePaymentLink" endpoint with dynamic co-pay.
3.5. Elation Health (Clinical & Billing APIs)
• Feature/Setting: Sync insurance details, export billing events.
• Sample: GET patient insurance, POST billing transaction.
3.6. Availity (Eligibility/Claim Clearinghouse API)
• Feature/Setting: Eligibility & benefit verification.
• Sample: Call Eligibility API before payment collection.
3.7. Office Ally (Transaction API)
• Feature/Setting: Process and fetch claim status, co-pay extraction.
• Sample: On claim update, pull co-pay, trigger payment flow.
3.8. Athenahealth (Patient Charge Estimator)
• Feature/Setting: Co-pay estimation at service time.
• Sample: Use "Estimate Charge" API post-visit.
3.9. GoCardless (Direct Debit API)
• Feature/Setting: One-off or scheduled co-pay collection.
• Sample: Create payment on co-pay trigger event.
3.10. PayPal (Invoice API)
• Feature/Setting: Automated invoice dispatch for co-pay.
• Sample: Use "CreateInvoice" and "SendInvoice" endpoints.
3.11. QuickBooks (Payments & Invoices API)
• Feature/Setting: Invoice generation and reconciliation.
• Sample: POST "Invoice" with co-pay code, sync with accounting.
3.12. Cerner (Patient Accounts API)
• Feature/Setting: Retrieve patient balance, post payments.
• Sample: Fetch patient balance, patch payments endpoint.
3.13. Epic (Patient Billing API)
• Feature/Setting: Payment posting, balance update.
• Sample: Use "Create Patient Payment" method with co-pay amount.
3.14. Twilio (SMS Notification API)
• Feature/Setting: SMS reminders for unpaid co-pays.
• Sample: Trigger "Send message" on payment event.
3.15. SendGrid (Transactional Email API)
• Feature/Setting: Email payment links and invoice status.
• Sample: Send "Transactional Email" with co-pay details.
3.16. FreshBooks (Accounting API)
• Feature/Setting: Track invoices, log payments.
• Sample: Create invoice for co-pay, use "Record Payment" endpoint.
3.17. Zoho Books (Invoice API)
• Feature/Setting: Invoice dispatch, payment status sync.
• Sample: Generate invoice, poll "GET Payments" for reconciliation.
3.18. Intuit (Payments API)
• Feature/Setting: Credit card/bank debits for co-pays.
• Sample: Initiate payment via "Charge" endpoint.
3.19. Bill.com (Payments API)
• Feature/Setting: Payment scheduling and approval logging.
• Sample: Trigger payment workflow for incoming co-pay.
3.20. SAP Concur (Expense API)
• Feature/Setting: Reconcile co-payments with employee/provider expenses.
• Sample: Log payment record to expense report via API.
Benefits
4.2. Enhances compliance through auditable digital trails.
4.3. Accelerates revenue collection with auto-reminders and simplified workflows.
4.4. Improves patient experience with easy, real-time payment options.
4.5. Centralizes payment tracking for staff efficiency and financial reporting.