Automated insurance claim submissions

Purpose

1.1. Streamline submission of insurance claims for alternative medicine services (e.g., acupuncture, naturopathy, chiropractic).
1.2. Ensure compliance with industry-specific claim formats and required documentation for faster approvals.
1.3. Eliminate manual entry, reduce administrative lag, minimize data errors, and accelerate payment cycles.
1.4. Enable practitioners to focus on client care rather than administrative tasks by leveraging automated, secure workflows.

Trigger Conditions

2.1. Completion of patient visit and entry of session summary into EHR or practice management system.
2.2. Digital upload or scan of required documentation (treatment notes, billing codes, signed consent, etc.).
2.3. Receipt of a patient request for insurance claim submission via web form or email.
2.4. Real-time trigger on finalized invoices for eligible services or batch triggers at set intervals.

Platform Variants

3.1. Kareo
• API: ClaimSubmission endpoint; auto-populate claim forms on invoice finalization.
3.2. DrChrono
• Function: Clinical API, Documents API; trigger e-claim creation upon chart note completion.
3.3. SimplePractice
• Feature: Insurance Billing Automation; enable webhook for submitted superbills.
3.4. JaneApp
• Feature: Insurance/Third Party Billing setting; listen for appointment finale to create claim.
3.5. AdvancedMD
• API: Claims API; auto-submit claim based on charge entry completion.
3.6. Office Ally
• API: SubmitClaims API; push claim batch files generated from practice records.
3.7. Availity
• Function: Provider Portal e-Claims; configure SFTP claim file drop for batch automation.
3.8. Waystar
• API: Claims Transmission endpoint; trigger real-time file transfer on document upload.
3.9. Calaxy Health
• Feature: Insurance Claims Module; schedule claim upload from daily closing report.
3.10. Healthie
• API: Insurance Claims API; automate claim from pre-coded superbills.
3.11. X12 EDI (Clearinghouse Integration)
• Function: Automated sending of standard 837P EDI files; configure endpoint for outgoing claim files.
3.12. Zapier
• App: Webhooks by Zapier; receive patient info and relay to insurance claim API.
3.13. Integromat (Make)
• Scenario: EHR to Claims API workflow; trigger batch or individual claim submissions.
3.14. Salesforce Health Cloud
• API: Health Insurance module workflow; instant claim-trigger from care event object.
3.15. Google Apps Script
• Script: Monitor form submit on Google Form (visit summary); auto-generate EDI and send claim.
3.16. Microsoft Power Automate
• Flow: Form or SharePoint trigger; parse details and perform HTTP request to claim endpoint.
3.17. DocuSign
• Feature: Envelope completed webhook; submit signed SOAP/claim forms automatically.
3.18. PandaDoc
• Feature: API or webhook on document finalization (treatment plan); send for claim automation.
3.19. SignNow
• API: Document complete webhook; relay signed document to claim workflow.
3.20. AWS Lambda
• Function: Serverless middleware; listen for EHR event, transform data, and POST claim to insurance API.

Benefits

4.1. Reduced claim processing times and administrative workload.
4.2. Improved data accuracy and regulatory compliance.
4.3. Enhanced cash flow and payment predictability for practitioners.
4.4. Improved patient satisfaction through streamlined paperwork and faster reimbursements.