Automated billing and insurance claim preparation

Purpose

1.1. Automate the creation, generation, and dispatching of billing statements and insurance claims for emergency dental services.
1.2. Automates extraction of treatment data, patient details, and insurance information from EMR/EHR systems.
1.3. Automator connects with insurance portals to pre-fill forms, submit claims, and track claim status automatically.
1.4. Automating follow-ups for denied/rejected claims, resubmission, and updating financial/claims records.

Trigger Conditions

2.1. Completion of dental emergency procedure recorded in EHR.
2.2. Patient discharge or checkout triggers automation process.
2.3. Scheduled batch automation at end-of-day for all unsent claims/bills.
2.4. Manual trigger by staff via workflow dashboard for exceptional cases.

Platform Variants (Software diversity, min. twenty platforms with function/API detailed):

3.1. Epic Systems
• Feature/Setting: HL7 data export; configure event-based HL7 transmission for billing data automating claims creation.
3.2. Dentrix
• Feature/Setting: Ledger API—automate extraction of procedure/billing info for insurance forms.
3.3. Open Dental
• Feature/Setting: e-Claims Integration—automated submission of ADA claim forms through partner clearinghouses.
3.4. CareStack
• Feature/Setting: Claim Automation module—set up claim triggers on treatment completion.
3.5. Athenahealth
• Feature/Setting: Billing API—automated bill creation and electronic submission.
3.6. Curve Dental
• Feature/Setting: Automated billing rules—trigger insurance claims with configured workflow scripts.
3.7. DentiMax
• Feature/Setting: Claims API—automator submits batch claims and auto-tracks response.
3.8. Availity
• Feature/Setting: Claims Management API—real-time submission and tracking automation for insurance claims.
3.9. Change Healthcare
• Feature/Setting: Claims & Denial Management API—automated claim routing and status updates.
3.10. Fishbowl Inventory
• Feature/Setting: Billing automation using invoice triggers for medical inventory used.
3.11. QuickBooks
• Feature/Setting: Invoice API—automating invoice generation and email dispatch to patients.
3.12. Xero
• Feature/Setting: Automated billing via Xero API on new patient records.
3.13. Stripe
• Feature/Setting: Payment Links API—send automated payment requests tied to dental procedures.
3.14. Plaid
• Feature/Setting: ACH Automation—automated bank debiting for patient copays.
3.15. Zapier
• Feature/Setting: Billing & claim automation workflows—auto-forward bills to accounting and claims to clearinghouses.
3.16. DocuSign
• Feature/Setting: Automated insurance authorization form sending and capture.
3.17. Adobe Sign
• Feature/Setting: API—automate digital signature collection for consent and claim forms.
3.18. Intercom
• Feature/Setting: Automated messaging workflows—status updates on billing/insurance progress.
3.19. SendGrid
• Feature/Setting: Transactional Email API—automated dispatch of claims and billing receipts.
3.20. Twilio SMS
• Feature/Setting: SMS API—send automated billing reminders and claim status notifications.
3.21. Salesforce Health Cloud
• Feature/Setting: Automated claim lifecycle tracking using Health Cloud automation.
3.22. Monday.com
• Feature/Setting: Automated workflow for billing/claims tasks with status movement triggers.
3.23. Google Sheets
• Feature/Setting: Sheets API—automated data logging for all bills and claims actions.
3.24. Microsoft Power Automate
• Feature/Setting: Prebuilt flows for billing/insurance processes automating multi-platform actions.

Benefits

4.1. Automates routine data entry, minimizing human error in billing and claims submissions.
4.2. Accelerates revenue cycle with automated claim preparation and follow-up.
4.3. Automated communications reduce payment delays and improve insurance claim turnaround.
4.4. Automation enhances compliance with payer/insurance regulatory requirements.
4.5. Automator frees staff for higher-value tasks, optimizing operational efficiency in dental emergency services.