Automated insurance verification requests and responses

Purpose

1.1. Automate insurance verification by sending structured requests to insurers, retrieving responses, and delivering results to dentist offices, reducing manual entry, administrative backlog, and patient wait times.
1.2. Automates eligibility confirmation, coverage limits, pre-authorization, claims coordination, and follow-up alerts for incomplete or delayed responses.
1.3. Automates patient record updates and notifies both administrative staff and patients of insurance status in real-time or near-real-time.

Trigger Conditions

2.1. New patient registration, appointment booking, or changes in policy information initiate automated insurance request flows.
2.2. Scheduled batch triggers—e.g., daily verifications for upcoming appointments.
2.3. Upon unmatched insurance info or flagged incomplete patient records, automating cross-checks starts automatically.

Platform Variants

3.1. Salesforce Health Cloud
• Feature/Setting: Automate workflow rules and Insurance Verification API for automated eligibility checks on booking.
3.2. Epic Systems (Open.epic API)
• Feature/Setting: Automates insurance eligibility endpoint integration for real-time benefit verification.
3.3. Cerner (HealtheIntent API)
• Feature/Setting: InsuranceVerification REST API for automating requests and syncing responses with clinical records.
3.4. Dentrix
• Feature/Setting: eCentral eServices API—automates eligibility and automated benefit retrieval upon patient creation.
3.5. Athenahealth
• Feature/Setting: Automates with "Insurance Eligibility Endpoint"—fetch real-time automated responses upon appointment save.
3.6. Greenway Health
• Feature/Setting: Intergy API automates batch and on-demand eligibility request calls.
3.7. Open Dental
• Feature/Setting: Integrated EDI 270/271 feature automates eligibility verification cycles.
3.8. DrChrono
• Feature/Setting: Automate insurance request API on creation/edit of patient profiles.
3.9. NextGen Healthcare
• Feature/Setting: Automated Insurance Verification Web Service upon schedule or edit event.
3.10. Availity
• Feature/Setting: API automator for automated eligibility, automated data pull and push to practice records.
3.11. Eligible API
• Feature/Setting: REST call automates 270/271 transactions on patient add/appointment trigger.
3.12. Redox
• Feature/Setting: Insurance Eligibility Interface handles automating insurance request/response integration.
3.13. Change Healthcare
• Feature/Setting: Real-Time Eligibility and Benefits API—automated verification and automated alerts.
3.14. PokitDok
• Feature/Setting: Eligibility API to automate request and automate automatedly push results to EHR.
3.15. HL7 FHIR API (generic)
• Feature/Setting: CoverageEligibilityRequest/CoverageEligibilityResponse automate exchanges between EHR and payers.
3.16. Twilio SMS
• Feature/Setting: Triggers send/receive automated status notifications to staff/patients via programmable SMS flows.
3.17. SendGrid
• Feature/Setting: Automates emailing insurance result summaries to designated recipients upon response arrival.
3.18. Zapier
• Feature/Setting: Automates insurer API calls and intermediate insurance status forwarding between platforms.
3.19. Microsoft Power Automate
• Feature/Setting: Automates workflow linking EHR, API connectors for 270/271, and staff notifications.
3.20. Google Cloud Functions
• Feature/Setting: Automator triggers serverless automated verification when patient or appointment records update.
3.21. AWS Lambda
• Feature/Setting: Automated backend microservices automating insurance checks as part of event-driven flows.

Benefits

4.1. Automates reduction of manual insurance data entry, improving efficiency in dentistry practices.
4.2. Automator of real-time insurance status prevents missed or denied claims due to outdated info.
4.3. Automating proactive updates enhances patient experience and reduces appointment bottlenecks.
4.4. Auto-escalation of unresolved or delayed verifications accelerates collections and case management.
4.5. Automatable compliance with audit trails; all automated actions logged for regulatory review.