Automated eligibility verification against program criteria

Purpose

1.1. Instantly verify prospective adult day care client eligibility by cross-checking submitted information against regulatory, insurance, financial, and program-specific criteria, including age, residency, medical condition, insurance coverage, income level, and required documentation, during initial intake.
1.2. Streamline onboarding, reduce manual screening, prevent errors, enhance compliance, and accelerate service provision by integrating with government, healthcare, and insurance databases/APIs for instant decisions.
1.3. Automatically notify staff and clients on eligibility status and required next steps.

Trigger Conditions

2.1. New client intake form submission online or via staff entry.
2.2. Uploaded documentation or ID verification initiation.
2.3. Changes or updates to regulatory/program eligibility criteria.

Platform Variants

3.1. Salesforce Health Cloud
• Feature: Flows + Apex invocable actions; configure Data import API to fetch and compare client data against requirements.
3.2. Microsoft Power Automate
• Feature: Automated workflow with HTTP connector; trigger flow on form submission and call state Medicaid API for eligibility.
3.3. Zapier
• Feature: Webhooks + Filter; configure triggered Zap to cross-check Google Sheets data, then send eligibility status email.
3.4. Workato
• Feature: Recipe builder; define job to fetch insurance data via FHIR API, compare with intake info, update eligibility field.
3.5. MuleSoft
• Feature: API orchestration; trigger eligibility flow on intake record, calling external REST services for validation.
3.6. Google Apps Script
• Feature: Script bound to Google Forms; on-submit, fetch public benefit API and update eligibility status in Sheets.
3.7. DocuSign
• Feature: Agreement workflow; use Connect event to trigger eligibility check script on signed intake.
3.8. Twilio
• Feature: SMS verification; use Twilio Verify API for mobile identity matching as part of eligibility flow.
3.9. Plaid
• Feature: Income verification API; configure Auth product to verify bank account ownership and income for eligibility.
3.10. Experian
• Feature: Precise ID API; integrate to confirm identity, age, and residency programmatically.
3.11. Okta
• Feature: Identity engine; run eligibility script post-user registration via Okta Workflow.
3.12. AWS Lambda
• Feature: Serverless function; manage intake event and call eligibility-checking APIs, returning status.
3.13. Google Cloud Functions
• Feature: Triggered by intake form submission; integrates directly with external program criteria APIs.
3.14. Azure Logic Apps
• Feature: Automated workflow; use HTTP step to check regulatory API based on client data.
3.15. IBM App Connect
• Feature: Event-driven flow; fetch and process client eligibility in healthcare ecosystem.
3.16. InterSystems HealthShare
• Feature: Automated connection to healthcare data for check against care program criteria.
3.17. Redox Engine
• Feature: Clinical eligibility API integration for cross-EHR verification.
3.18. Formstack
• Feature: Conditional logic plus webhook; on form submit, call validation endpoint and set eligibility flag.
3.19. Smartsheet
• Feature: Automated workflows; trigger action on updated rows containing intake data, with eligibility script.
3.20. HubSpot
• Feature: Workflows; trigger webhook on contact creation to invoke eligibility API.
3.21. Jotform
• Feature: Webhooks; send client intake responses to eligibility-check API and receive results.
3.22. AirTable
• Feature: Scripting Automation; on form record creation, connect to external program criteria APIs.

Benefits

4.1. Accelerates and standardizes onboarding for regulatory compliance.
4.2. Minimizes manual review, reducing resource overhead and human error.
4.3. Enables automated client communication for transparency and improved experience.
4.4. Centralizes reporting and audit trails for program administrators.
4.5. Scales intake to handle fluctuating demand without delays.