Patient Intake and Onboarding Automation**Purpose**
1.2. Automatically checks active policies, deductible status, coverage limits, plan types, and benefit levels by connecting with payer APIs.
1.3. Eliminates manual validation and calls, providing faster admissions and less administrative burden.
1.4. Pre-fills patient EMR/EHR profiles with insurance data, improving data accuracy and onboarding completion.
1.5. Sends real-time eligibility feedback to staff for immediate patient communication.
**Trigger Conditions**
2.2. Uploaded insurance card/scanned document detected.
2.3. Patient appointment scheduled or pre-admission check initiated.
2.4. Periodic eligibility re-check (e.g., monthly, at program milestones).
2.5. Staff request for verification action in system UI.
**Platform Variants & Integration Functions**
3.1. Experian Health
• API Feature: Coverage Discovery API — configure API key, supply patient demographics/insurance info, receive real-time status.
3.2. Availity
• Service: Eligibility & Benefits Inquiry 270/271 EDI — connect clearinghouse account, automate 270 EDI submission, retrieve 271 response.
3.3. Change Healthcare
• API: Insurance Eligibility Verification — use Eligibility API, map standard patient metadata fields, schedule synchronous or batch checks.
3.4. PokitDok
• Endpoint: /eligibility — provide payer ID, member ID; configure webhook for instant eligibility response.
3.5. Waystar
• API/Platform: Eligibility Verification — map patient registration flows; receive and parse plan/coverage JSON.
3.6. Health Gorilla
• API: Insurance Eligibility — enable insurance network, set API credentials, request and auto-store payer responses.
3.7. Eligible
• API: Verify endpoint — send insurance policy info via REST API; auto-push eligibility response data to EHR.
3.8. Surescripts
• Feature: Eligibility/Benefits Real-Time 270/271 — configure integration with EHR for direct eligibility checks.
3.9. TriZetto Provider Solutions
• API Module: Real-time Eligibility — supply practice credentials for online patient checks; auto-populate intake form.
3.10. Office Ally
• Feature: Eligibility Verification Tool — configure batch import for scheduled verification; map output to patient files.
3.11. EPIC (EHR System)
• Function: Insurance verification via API integration — set automated callouts when patient is added/edited in EMR.
3.12. Athenahealth
• API: Insurance Eligibility endpoint — authenticate via OAuth, set monitoring workflow for patient eligibility on intake.
3.13. Kareo
• Feature: Real-Time Eligibility Check — trigger from appointment booking; send response to practice staff.
3.14. NextGen Healthcare
• EDI Integration: 270/271 module — connect to EHR to auto-run eligibility when new patient insurance data logged.
3.15. Greenway Health
• Built-in Eligibility API — enable in admin, configure patient flows to auto-trigger when insurance updated.
3.16. Salesforce Health Cloud
• External Services/Custom Flows — embed insurance verification API calls into intake journeys; auto-log results in patient record.
3.17. InterSystems
• Health Connect Platform: Insurance Eligibility Verification — add eligibility channel, map to core patient data objects.
3.18. Redox
• API: Insurance Eligibility Query — connect EHR or CRM system event to trigger Redox eligibility query.
3.19. Cerner
• PowerChart Custom Apps: Eligibility Check integration — set up as part of patient admission protocols.
3.20. Meditech
• Interface: Real-time eligibility connection — schedule checks for new patients, map coverage data to EMR fields.
3.21. Google Cloud Healthcare API
• Feature: FHIR-compliant eligibility API; structure request with insurance parameters, receive payer bundle response.
3.22. AWS HealthLake
• API Integration: Automate checks using FHIR endpoint and Lambda trigger from patient intake events.
**Benefits**
4.2. Reduces staff workload and minimizes denied claims.
4.3. Improves patient experience with immediate, accurate feedback.
4.4. Ensures regulatory and reimbursement compliance.
4.5. Enables faster revenue cycle by preventing eligibility-related rework.