Scheduled submission of claims to insurance/Medicaid

Purpose

1. Automate the preparation, validation, and scheduled electronic submission of claims to insurance and Medicaid systems for adult foster care billing cycles.

2. Ensure compliance with payer billing requirements, reduce manual entry errors, drive timely reimbursements, and allow staff to focus on client care and analytics.

3. Aggregate claim data from EHR, attendance tracking, and care logs, validate eligibility, and submit batches at scheduled intervals directly to insurance/Medicaid clearinghouses.

Trigger Conditions

1. Pre-set schedule (e.g., daily, weekly, by end-of-month billing cycle).

2. Detection of new billable events or service logs entered into EHR or attendance systems.

3. Receipt of all required supporting documentation and approvals.

4. End of shift or end-of-day system-wide data lock.

5. Confirmation that no compliance holds or missing data are detected in the claim batch.

Platform Variants

1. Salesforce Health Cloud

• Feature/Setting: Scheduled Flow Builder — set timed automation to push claim tasks using Apex or Flow.
  

2. Microsoft Power Automate

• Feature/Setting: Scheduled Cloud Flows — configure to export EHR data and submit via HTTP to APIs.
  

3. Google Cloud Functions

• Feature/Setting: Cron scheduler — auto-run scripts that perform claim packet preparation and send via REST.
  

4. Zapier

• Feature/Setting: Schedule trigger + Webhooks by Zapier — trigger claim file submission at interval to payer API endpoint.
  

5. Make (Integromat)

• Feature/Setting: Scheduler + HTTP module — submit FHIR/EDI-formatted claims to third-party endpoints.
  

6. AWS Lambda

• Feature/Setting: CloudWatch Events — timed Lambda to transform claim data and send via API Gateway.
  

7. Workato

• Feature/Setting: Scheduler Recipe — periodic claims export and submission using HTTP connectors.
  

8. Oracle Cloud Integration

• Feature/Setting: Scheduled Integration Flows — compile and transmit claim data to external payers.
  

9. IBM App Connect

• Feature/Setting: Scheduled integration to collect billing details; send to Medicaid endpoint.
  

10. Azure Logic Apps

• Feature/Setting: Recurrence Trigger + HTTP Action — automate submission to clearinghouses.
  

11. UiPath

• Feature/Setting: Orchestrator schedules — robotic claim data extraction, validation, and EDI file transmission.
  

12. Boomi

• Feature/Setting: AtomSphere Process Schedules — trigger claim export and mapping to payer API.
  

13. Jitterbit

• Feature/Setting: Scheduler — automated data pull, transformation, and API submission for claims.
  

14. MuleSoft

• Feature/Setting: Scheduler Flow — regular export and HTTP request to submit claims.
  

15. Pabbly Connect

• Feature/Setting: Scheduled Automations — batch extraction from billing system and transmission.
  

16. Tray.io

• Feature/Setting: Scheduled and Loop Logic — gather claims and submit via HTTPS to recipient.
  

17. Smartsheet

• Feature/Setting: DataMesh Workflow + Scheduled File Delivery — push CSV claims at interval.
  

18. Quick Base

• Feature/Setting: Automations + Scheduled script — export eligible claims and push to clearing systems.
  

19. Epic Systems (EHR)

• Feature/Setting: Batch processing job — periodic claim file generation and outbound interface to Medicaid/insurance APIs.
  

20. Mediware (CareTend)

• Feature/Setting: Scheduled Claims Export — automatic nightly or monthly EDI file creation and API transmission.
  

21. Kareo

• Feature/Setting: Automated Billing Rules — time-based submission to insurance and Medicaid via clearinghouse.
  

22. AdvancedMD

• Feature/Setting: Automatic Claims Submission Scheduling — direct definitions of claim push intervals and clearinghouse interface setup.
  

Benefits

1. Minimized claim delays, rejection rates, and staff administrative burden.

2. Improved cash flow with predictable payment timelines.

3. Enhanced compliance due to automated error checking and audit trail generation.

4. Scalability for high claim volumes across multiple homes/locations without increased operational cost.

5. Integration flexibility with diverse payer systems and EHR solutions.

6. Immediate notifications of submission success/failure for rapid corrective action.