Patient Management AutomationsPurpose
1.2. Automate data retrieval from practice management/EHR, cross-check patient details with insurance databases, verify coverage instantly, and update records.
1.3. Automatically inform clinic staff and patients about coverage status, handle follow-ups for missing/incomplete data, and maintain audit logs for compliance.
1.4. Integrate confirmation/denial notifications in the patient’s medical record, notify billers for secondary insurance, and automate tasks for required documents.
Trigger Conditions
2.2. Updated/added insurance information to an existing patient.
2.3. Scheduled first appointment for a patient with “unverified” insurance status.
2.4. Manual request for re-verification by front-desk or billing team.
Platform Variants
3.1. Epic EHR
• API: Patient Insurance Verification
• Configure webhook for “new/updated insurance info”; trigger insurance verification call, log status in patient chart.
3.2. Athenahealth
• API: Insurance Eligibility Check
• Set eligibility rule on new appointment or patient registration; auto-check coverage using insurance plan code.
3.3. Cerner
• Function: PowerChart Eligibility Verification
• Set automated task on patient intake; pulse status to front-desk within Cerner dashboard.
3.4. Kareo
• API: Insurance Verification
• Webhook for “new patient added”; auto-submit info to API and fetch response to patient’s file.
3.5. DrChrono
• API: Insurance Verification Endpoint
• Use automation rule on “appointment scheduled”; send request, update insurance tab when eligible/denied.
3.6. NextGen Healthcare
• API: Eligibility Verification
• Scheduled batch jobs on daily/weekly basis for upcoming appointments; update patient status.
3.7. eClinicalWorks
• Feature: Real-Time Eligibility Check
• Trigger on demographic edit or new registration; push outcome to patient alerts.
3.8. Rectangle Health
• API: Verify Insurance
• Link PMS to Rectangle Health; nightly batch processing for all uninsured/unknown coverage.
3.9. Medisoft
• Setting: Insurance Discovery Service
• On-demand and scheduled check for insurance gaps; sync insurance outcome to billing queue.
3.10. Availity
• Function: Eligibility & Benefits API
• Integrate REST call within patient onboarding; parse coverage responses and flag discrepancies.
3.11. Change Healthcare
• API: Real-Time Eligibility
• Trigger on appointment creation; log response in audit/insurance verification tracker.
3.12. Experian Health
• API: Patient Insurance Eligibility
• Set rule on patient registration, trigger API with patient/demo data; report real-time status to EHR.
3.13. PokitDok (now Change Healthcare)
• API: Insurance Verification
• Run check on patient import/upload, append detailed status to patient file.
3.14. Office Ally
• Feature: Eligibility Real Time
• On appointment confirmation, send patient/insurance data, assign result to patient portal.
3.15. Salesforce Health Cloud
• Flow: Eligibility Verification Flow
• Fire action on new patient record, integrate eligibility result into case record.
3.16. Zapier
• App: Webhooks by Zapier
• Trigger when patient data is updated; send webhook to insurance verification API, capture webhook outcome to master sheet.
3.17. Google Sheets
• App Script: On Form Submit
• Auto-trigger insurance check when new patient row is created, import outcome to linked billing tab.
3.18. Twilio SMS
• Feature: API Request Notification
• On verified/unverified result, SMS patient/front-desk with coverage outcome and next steps.
3.19. SendGrid
• Feature: Automated Email Notification
• Email billing/clinic with eligibility denial or approval, attach PDF copy of result for record-keeping.
3.20. Slack
• Feature: Incoming Webhooks
• Real-time status notification to front-desk/billing team channel when status changes.
Benefits
4.2. Minimizes staff workload and data entry errors.
4.3. Enhances clinic and patient communication.
4.4. Accelerates new patient onboarding and billing.
4.5. Increases overall patient satisfaction and operational efficiency.