Insurance verification and eligibility checks

Purpose

1.1. Automate insurance verification and eligibility checks to streamline patient intake, reduce manual data entry, minimize errors, and accelerate patient onboarding.
1.2. Automates cross-checking of patient demographics with insurer databases in real-time for denture care services.
1.3. Eliminates wait times by automating requests and responses for coverage status, plan details, and pre-authorizations from insurers.
1.4. Automator processes and records eligibility status in practice management software for future reference and compliance.

Trigger Conditions

2.1. Patient submits new appointment request via web form or phone.
2.2. New patient registration/record created in clinic’s CRM or EHR system.
2.3. Appointment scheduled by staff in scheduling software.
2.4. Insurance card uploaded or insurance information updated by patient or staff.
2.5. Scheduled routine batch verification for upcoming appointments.

Platform Variants

3.1. Salesforce Health Cloud
• Feature/Setting: Configure Process Builder or Flow with Health Cloud Insurance Verification API for automated eligibility checks at entry.
3.2. Epic Systems
• Feature/Setting: Use Epic Bridges integration to EDI 270/271 Eligibility & Benefits Inquiry/Response.
3.3. Dentrix
• Feature/Setting: Enable OpenDental Insurance Eligibility automation using electronic clearinghouse APIs.
3.4. Availity
• Feature/Setting: API endpoint for real-time eligibility & benefits; set to auto-trigger on new patient intake.
3.5. Change Healthcare
• Feature/Setting: REST API for eligibility and verification; automate using Nightly Verification scheduling.
3.6. Oscar Health
• Feature/Setting: Invoke Eligibility Check endpoint; automate trigger post-registration.
3.7. Athenahealth
• Feature/Setting: Automated eligibility check via Patient Information API integration.
3.8. Zendesk
• Feature/Setting: Use Zendesk Sunshine for automating ticket creation and status update post insurance verification event.
3.9. Zapier
• Feature/Setting: “Schedule” Trigger with webhook to insurance API for every new entry in patient spreadsheet.
3.10. Google Cloud Healthcare API
• Feature/Setting: FHIR resources automated eligibility validation workflow; configure with Pub/Sub triggers.
3.11. Microsoft Power Automate
• Feature/Setting: Use EHR connectors and automate eligibility checks with scheduled flow.
3.12. BambooHR
• Feature/Setting: Automate bulk eligibility check for employee dental benefits via API integration.
3.13. Medisoft
• Feature/Setting: Set up automated eligibility verification using partner clearinghouse module.
3.14. NextGen Healthcare
• Feature/Setting: Connect EDI module to automate batch eligibility inquiries nightly.
3.15. DentiMax
• Feature/Setting: Activate automated eligibility checks for all new patients using integrated clearinghouse settings.
3.16. DentalXChange
• Feature/Setting: Use Real-Time Eligibility API endpoint, automate via appointment system integration.
3.17. Slack
• Feature/Setting: Automated notification in #insurance-verifications channel when eligibility status changes.
3.18. HubSpot
• Feature/Setting: Automate workflow to assign tasks based on failed eligibility via custom API trigger.
3.19. OpenEMR
• Feature/Setting: Enable batch and on-demand automated eligibility verification using X12/EDI integration.
3.20. Greenway Health
• Feature/Setting: Automate eligibility check workflow with Real-Time Transaction Manager and EDI links.

Benefits

4.1. Automates end-to-end insurance eligibility workflow for denture care, reducing manual effort and human errors.
4.2. Automating eligibility checks improves onboarding speed, reducing delays for patients and staff.
4.3. Automated systems provide real-time notifications, ensuring immediate action on insurance denials or updates.
4.4. Improves compliance and audit-ready documentation by automatedly tracking all communications and verifications.
4.5. Automation leads to higher patient satisfaction due to speedy eligibility confirmation and reduced claim denials.