Billing & Revenue Cycle AutomationPurpose
1.2. Reduce lag between payer response and corrective action for Allergy & Immunology practices.
1.3. Help in tracking denial patterns for improved revenue cycle management.
1.4. Facilitate escalation processes when denial rates surpass defined thresholds.
1.5. Automate documentation and communication for audit trails and compliance.
Trigger Conditions
2.2. Status update from clearinghouse or EHR system indicating failed submission.
2.3. Manual entry by staff updating a record to ‘denied’ or ‘rejected’.
2.4. Receipt of X12 EDI 835 transaction with denial codes.
2.5. Predefined thresholds crossed (e.g., more than X denials/day).
Platform Variants
3.1. Twilio SMS
• Feature/Setting: Programmable SMS; integrate with webhook to send real-time texts to billing staff when a denial event triggers.
• Sample: POST to /Messages with To, Body (Denial details), From.
3.2. SendGrid
• Feature/Setting: Email API; auto-send customized email alerts including denial reason and patient reference.
• Sample: POST to /mail/send with recipient email, subject: “Denial Alert: [Claim#]”.
3.3. Slack
• Feature/Setting: Incoming Webhooks; push denial notifications to a channel for team awareness and quick discussion.
• Sample: Webhook URL, JSON payload {“text”: “Denied claim #12345 … ”}.
3.4. Microsoft Teams
• Feature/Setting: Connector/Incoming webhook; send adaptive cards with denial summary to Billing group.
• Sample: POST to Teams webhook with card content.
3.5. PagerDuty
• Feature/Setting: Event API v2; escalate persistent denials to on-call supervisor for urgent intervention.
• Sample: POST /v2/enqueue with incident trigger.
3.6. Salesforce Health Cloud
• Feature/Setting: Workflow automation; auto-create task for denied claims tagged by patient ID.
• Sample: Configure Process Builder/Flow to trigger new task assignment.
3.7. Cerner Millennium
• Feature/Setting: PowerChart Event Notifications; push real-time alerts to care team workspace when denial records update.
• Sample: Subscribe to event, map denial code, notify via desktop/mobile.
3.8. Epic Systems
• Feature/Setting: Interconnect API; flag denial in Hyperspace workflow, notify revenue cycle staff.
• Sample: Configure outbound message on relevant status change.
3.9. Gmail
• Feature/Setting: Send email using Gmail API; relay detailed claim denial alert to selected addresses.
• Sample: POST to /send, attach denial PDF if needed.
3.10. Outlook / Microsoft 365
• Feature/Setting: Send mail with Graph API; populate templated denial notification to billing mailbox.
• Sample: POST /me/sendMail with subject, content.
3.11. Zendesk
• Feature/Setting: Ticket creation via Support API; auto-open a denial handling ticket for each event.
• Sample: POST /api/v2/tickets with custom fields.
3.12. Jira Service Management
• Feature/Setting: Create issue API; log a “denial case” with attached EOB and workflow steps.
• Sample: POST /rest/api/2/issue.
3.13. Asana
• Feature/Setting: Tasks API; auto-create and assign billing denial tasks with due dates.
• Sample: POST /tasks with description.
3.14. Monday.com
• Feature/Setting: Item creation; log each denial as new board item under “Revenue Cycle” group.
• Sample: Create item by API with dynamic fields.
3.15. Google Sheets
• Feature/Setting: Sheets API; append rows with denial details for analytics.
• Sample: POST to /append.
3.16. Dropbox
• Feature/Setting: Save denial reports in designated folder using API; share access with compliance.
• Sample: POST /files/upload.
3.17. DocuSign
• Feature/Setting: Envelope API; route denied claim review forms for required signatures.
• Sample: POST /envelopes with recipient and document.
3.18. Smartsheet
• Feature/Setting: Add row via API; track denials and status notes in workflow sheet.
• Sample: POST /sheets/{sheetId}/rows.
3.19. Freshdesk
• Feature/Setting: Ticket API; generate support ticket for every claim denial, assign to Billing.
• Sample: POST /api/v2/tickets.
3.20. HubSpot
• Feature/Setting: CRM timeline events; log denial as a new event on patient/company record.
• Sample: POST /crm/v3/timeline/events.
Benefits
4.2. Improves staff accountability by assigning follow-ups instantly.
4.3. Centralizes denial data across communication, task, and documentation tools.
4.4. Enables pattern analysis for denials, supporting smarter prevention strategies.
4.5. Enhances revenue integrity, audit trails, and compliance posture.