Automated insurance verification requests

Purpose

1.1. Automate the process of insurance verification for diabetes center patients before appointments.
1.2. Eliminate manual calls, faxes, or emails to insurers for eligibility and coverage checks.
1.3. Automatedly collect and validate patient insurance information in advance of scheduled appointments, reducing front-desk workload.
1.4. Facilitate automated notifications to patients regarding approval or required additional details.
1.5. Provide a seamless, automated workflow between EHR/EMR, patient portal, insurance provider APIs, and communication platforms.

Trigger Conditions

2.1. New patient registration or appointment booking in scheduling system.
2.2. Update in existing patient’s insurance details or expiration date approaching.
2.3. Manual trigger by staff for ad-hoc verifications.
2.4. Automated daily or weekly batch verification runs for all upcoming appointments.

Platform Variants

3.1. Epic EHR
• Feature/Setting: OnNewPatientRecord webhook or AppointmentScheduled API; configure outbound HL7 or FHIR messages for automation.
3.2. Cerner
• Feature/Setting: PowerChart Message Center APIs; automate insurance eligibility requests using Cerner Open Developer Experience (code: /insuranceEligibility).
3.3. athenahealth
• Feature/Setting: /patients/{patientid}/insurance endpoint; automatedly invoke on registration workflows.
3.4. Greenway Health Intergy
• Feature/Setting: InsuranceEligibilityValidation API; schedule automated triggers for daily verifications.
3.5. NextGen Healthcare
• Feature/Setting: PatientInsuranceEligibilityCheck web service with automated triggers for appointment creation.
3.6. AdvancedMD
• Feature/Setting: Insurance Card Scanning and automated eligibility check module configuration.
3.7. Kareo
• Feature/Setting: Insurance Verification API; automate post-intake workflows.
3.8. Change Healthcare
• Feature/Setting: Real Time Eligibility (RTE) API; configure automated batch or real-time checks.
3.9. Availity
• Feature/Setting: Automated Eligibility and Benefits (AEB) batch file processing; utilize Availity API for automating single or bulk inquiries.
3.10. Experian Health
• Feature/Setting: Eligibility web service integration to automate eligibility check at intake with real-time response configuration.
3.11. Office Ally
• Feature/Setting: Eligibility Request API endpoint; set up scheduler for automated file batch uploads.
3.12. Practice Fusion
• Feature/Setting: Automated insurance eligibility notifications with integration points for eligibility status webhook.
3.13. DocuSign
• Feature/Setting: PowerForms API to automate collection of insurance documentation and e-sign verification forms.
3.14. Salesforce Health Cloud
• Feature/Setting: Care Plan automation using Process Builder to trigger insurance verification tasks.
3.15. Twilio
• Feature/Setting: Programmable Messaging; configure automation to send SMS alerts to patients after insurance check.
3.16. SendGrid
• Feature/Setting: Automated Transactional Email API for notifying patients about insurance verification results.
3.17. Microsoft Power Automate
• Feature/Setting: Automated flows integrating EHR webhook triggers to external insurance APIs using HTTP actions.
3.18. Zapier
• Feature/Setting: Automated Zaps with New Calendar Event > Insurance Verification API > Slack/Email automation.
3.19. Google Workspace (Apps Script)
• Feature/Setting: Automated script to process forms and trigger insurance API calls when a new spreadsheet row is added.
3.20. AWS Lambda
• Feature/Setting: Serverless automation of insurance verification via API Gateway endpoints, invoked by event triggers such as SQS or S3 updates.
3.21. Oracle Health
• Feature/Setting: Eligibility verification integration with Oracle’s Healthcare Cloud APIs for process automation.
3.22. Redox
• Feature/Setting: Automated data integration with Redox Insurance Eligibility API to connect multiple EHR systems.

Benefits

4.1. Automatedly reduces manual entry and repetitive calls for verification.
4.2. Automates real-time eligibility results, preventing coverage-related delays or rejections.
4.3. Improves staff efficiency and enhances patient experience through proactive, automated communication.
4.4. Reduces insurance denials and billing issues via instant, accurate automation.
4.5. Automating ensures compliance and audit trails for all verification steps.