Billing & Revenue Cycle AutomationPurpose
1.2. Retrieve real-time patient insurance data from multiple payers to determine their financial responsibility instantly.
1.3. Eliminate manual verification steps, reducing claim errors and administrative overhead.
1.4. Integrate seamlessly with practice management systems, EHRs, and clearinghouses for end-to-end automation.
1.5. Generate accurate billing statements incorporating copay, deductible computations, and coverage details.
1.6. Enhance patient experience by providing upfront financial clarity and reducing surprise bills.
Trigger Conditions
2.2. Patient check-in event from front desk or patient portal.
2.3. Submission of allergy/immunology procedure codes for pre-authorization or billing.
2.4. Receipt of patient insurance card or policy change notification.
2.5. On claim ready status for eligibility verification and benefits check.
Platform Variants
3.1. Availity
• API: Real-Time Eligibility & Benefits — Configure to auto-query patient insurance details at appointment creation.
3.2. Change Healthcare
• Service: Eligibility Verification — Auto-fetch deductibles/copays using x12 270/271 transactions.
3.3. Epic
• Integration: Coverage Eligibility API — Connect to schedule routine checks pre-encounter.
3.4. Cerner
• Solution: Revenue Cycle Edge — Set eligibility verification rules for allergy care workflows.
3.5. Athenahealth
• API: Insurance Eligibility — Set up triggers for patient registration or scheduling.
3.6. Allscripts
• Module: Practice Management Eligibility — Enable real-time calculation during check-in.
3.7. Kareo
• Feature: Real-Time Eligibility Check — Automate review of copays on service scheduling.
3.8. Greenway Health
• API: Insurance Verification — Auto-pull deductibles/copays per new encounter entry.
3.9. AdvancedMD
• Feature: Eligibility Verification — Hook to appointment booking for automated calculation.
3.10. DrChrono
• API: Patient Insurance Verification — Schedule automatic policy lookup and calculation.
3.11. eClinicalWorks
• API: Insurance Eligibility — Auto-trigger benefit check on appointment creation.
3.12. NextGen Healthcare
• Module: Real-Time Eligibility — Sync patient data on intake for calculation.
3.13. Office Ally
• API: Eligibility Verification — Configure nightly batch automation for allergy patients.
3.14. Practice Fusion
• Feature: Insurance Verification Integration — Set live trigger for copay computation.
3.15. Meditech
• Solution: Client Server Eligibility — Automate concurrent coverage and patient responsibility checks.
3.16. Experian Health
• API: Eligibility & Coverage Discovery — Schedule API pull upon patient demographics update.
3.17. Health Gorilla
• API: Eligibility Check — Link to EHR patient onboarding events for automated reviews.
3.18. SimplePractice
• Feature: Insurance Eligibility Integration — Enable synchronous checks before billing.
3.19. Zirmed (Waystar)
• API: Eligibility Solution — Automate at procedure code entry for copay/deductible fetch.
3.20. Optum360
• Service: API Hub Eligibility — Connect at check-in for live insurance analysis.
3.21. PokitDok
• API: Eligibility X12 — Automate policy status verification during billing review.
3.22. Redox
• API: Eligibility — Enable rule-based copay/deductible assessments upon data change events.
Benefits
4.2. Accelerated claim submission and reduced denials due to improved accuracy.
4.3. Immediate patient financial transparency at intake or scheduling.
4.4. Decreased workload for front office and billing staff.
4.5. Integration with multiple EHRs and payers improves provider cash flow predictability.
4.6. Enhanced patient trust by providing clear, upfront cost estimates at every encounter.