Routine eligibility re-verification scheduling

Purpose

1.1. Automate recurring checks on patients’ insurance eligibility, ensuring compliance with regulations and maintaining up-to-date documentation for each visit.
1.2. Increase operational efficiency by reducing manual staff work, thereby minimizing eligibility errors and claim denials.
1.3. Enhance patient experience via proactive eligibility confirmation, minimizing treatment delays.

Trigger Conditions

2.1. New or upcoming patient appointments detected in EMR/EHR.
2.2. Scheduled periodic interval (e.g., every 3, 6, or 12 months, based on payer policies).
2.3. Insurance expiration or policy update notice received.
2.4. Patient-initiated request for eligibility validation via portal or phone.

Platform variants

3.1. Epic Systems
• Feature/Setting: Scheduling API, configure webhook to monitor patient appointment events, set eligibility logic.
3.2. Cerner
• Feature/Setting: Appointment Event API, build FHIR service calling eligibility verification.
3.3. athenahealth
• Feature/Setting: Appointments API for triggers, Insurance Eligibility Endpoint for re-verification.
3.4. eClinicalWorks
• Feature/Setting: Integration via HL7, configure eligibility module schedule.
3.5. Allscripts
• Feature/Setting: API for Patient Demographics, enable scheduled eligibility call with payer APIs.
3.6. Kareo
• Feature/Setting: Rules Engine for scheduled tasks, Insurance Eligibility API call configuration.
3.7. Practice Fusion
• Feature/Setting: Workflow Automation, set recurring eligibility API triggers.
3.8. Greenway Health
• Feature/Setting: Reminders/Automations, eligibility API integration per schedule.
3.9. NextGen Healthcare
• Feature/Setting: Event Manager for triggers, Insurance Verification integration.
3.10. DrChrono
• Feature/Setting: Scheduled Appointment API, Insurance Verification API for automation.
3.11. Salesforce Health Cloud
• Feature/Setting: Flows for eligibility verification, Data Connector for EHR sync.
3.12. Microsoft Power Automate
• Feature/Setting: Scheduled cloud flows, trigger on calendar events, HTTP action for eligibility check.
3.13. Zapier
• Feature/Setting: Scheduler trigger, Webhooks for custom eligibility verification APIs.
3.14. Integromat (Make)
• Feature/Setting: Scheduled scenarios, HTTP module for eligibility data calls.
3.15. Twilio
• Feature/Setting: SMS notifications for re-verification prompts, Programmable Messaging API.
3.16. SendGrid
• Feature/Setting: Automated email reminders for eligibility, Transactional Templates.
3.17. Slack
• Feature/Setting: Scheduled message API to staff/teams for pending verifications.
3.18. Google Calendar
• Feature/Setting: Event triggers for eligibility re-verification dates, API integration.
3.19. AWS Lambda
• Feature/Setting: Scheduled lambda triggering eligibility check with payer APIs.
3.20. Azure Logic Apps
• Feature/Setting: Recurrence trigger, connector for eligibility API calls.
3.21. SFTP/FTP Servers
• Feature/Setting: Scheduled eligibility batch file transfers for payer processing.

Benefits

4.1. Ensures regulatory and insurance compliance for each visit.
4.2. Minimizes claim denials due to outdated or incorrect payer info.
4.3. Reduces manual follow-up effort by automating routine verification.
4.4. Increases patient trust and practice efficiency.
4.5. Offers audit-ready documentation trails for quality and compliance reviews.