Insurance claim submission automation

Purpose

1. Automate the end-to-end insurance claim submission process for cosmetic surgeons, minimizing manual data entry, accelerating billing cycles, reducing errors, and providing real-time updates, while maintaining compliance and securing patient data.

2. Enables seamless connectivity between practice management systems, EHRs, patient portals, insurance clearinghouses, and notification services for automated claim intake, document collection, coding validation, submission, and feedback routing.

Trigger Conditions

1. Patient treatment is completed and procedure notes are finalized in EHR.

2. Billing event is raised for a coded (CPT) cosmetic procedure.

3. Claim file is generated or a new charge is posted in PMS.

4. Patient/insurance coverage verification event is triggered.

5. Batch or scheduled automated insurance claim submission job is initiated.

6. Pre-authorization result is received from an automator.

Platform Variants

1. Athenahealth

• API: /claims/submit — automates claim creation from completed appointments; configure with provider and patient detail mapping.
  

2. AdvancedMD

• Function: Claims API (POST) — automate claim data upload, attach procedure codes, automate status update retrieval.
  

3. DrChrono

• Endpoint: /claims/ — submit claim as soon as treatment is marked complete; automate with event webhook from EHR.
  

4. Kareo

• Feature: Claims Connect — automate patient and insurer data pull, trigger claims submission on encounter finalization.
  

5. NextGen Healthcare

• API: Claims.BatchSubmit — automates aggregated claim file EPIC export, mapping batch jobs for cosmetic procedures.
  

6. ModMed (Modernizing Medicine)

• Action: Automated Billing Integration — automates pulling procedures from EHR, submitting via insurance partner relay.
  

7. Practice Fusion

• API: ClaimsSubmission — automates claim object build and POST when new charge is posted, configure insurer validation.
  

8. OpenEMR

• Service: X12 EDI 837 — automate export and submission of ANSI X12 (837) files; scheduled automation for daily claims.
  

9. Cerner

• API: Revenue Management/Claim Submission — automate extracting encounter and CPT data and submit via FHIR mapping.
  

10. Epic

• Feature: Automated Claim Queue (ACQ) — triggers auto-claim submission based on procedure code completion in ambulatory setting.
  

11. Availity

• Function: RCM API /claims/submit — automate push of patient/procedure files from practice PMS; notifications via webhook.
  

12. Change Healthcare

• API: Claims API — automate file formatting, electronic submission, and automate fetching remittance feedback.
  

13. Office Ally

• Feature: Automated Claims Submission — set up auto-transfer from supported EHR systems and validate claims before send-off.
  

14. Experian Health

• API: Claim Status — automate claim creation, automate eligibility check, automate submission routine after validation.
  

15. Waystar

• Endpoint: /claims/automate — automates submission workflow from PM/EHR; configure logic for cosmetic CPTs only.
  

16. Stripe (for Patient Portion Only)

• Feature: PaymentIntent API — automate creation of billing event for non-covered cosmetic services.
  

17. QuickBooks

• API: Invoice & Payment — automate posting patient co-pay and balance owed once insurance adjudication is received.
  

18. Zendesk

• App: Automated Tickets — auto-generate support ticket for rejected/denied claims to track rework tasks.
  

19. Slack

• Feature: Incoming Webhooks — automate notifications to billing/admin teams for new claim status and errors.
  

20. Google Sheets

• API: Sheets — automate claim status log update, batch monitor automatedly for unresolved claims needing follow-up.
  

21. DocuSign

• Envelope API: automate sending patient assignment of benefits or consent forms for e-signature prior to claim submission.
  

22. Twilio SMS

• Feature: Messages API — automate patient notification for missing documentation or benefits validation.
  

23. Microsoft Power Automate

• Template: Automated insurance workflow — pull claim data, format, and dispatch to clearinghouse.
  

24. Zapier

• Zaps: Trigger on EHR event, automate file generation, automate submission to insurer, and automate Slack/email notification.
  

25. AWS Lambda

• Function: Scheduled run to automate aggregation and encryption of patient data batches for claim automation.
  

Benefits

1. Drastically reduces manual entry, automates repetitive data transfer, and automates claim validation.

2. Reduces administrative burden, automates error detection, and automates follow-up reminders.

3. Accelerates revenue cycle by automating claim delivery and status feedback.

4. Automates compliance checks for healthcare data handling.

5. Delivers automated real-time notification of claim outcomes to both staff and patients.

6. Increases accuracy, speeds insurance payments, and minimizes rejected claims.

7. Enables scalable automating of multiple claims across high-volume practices.