Purpose
1. Automate the process of sending reminders for resubmission of rejected medical claims to reduce revenue loss and ensure timely follow-ups.
2. Automated reminders minimize manual tracking, speed up the denial resolution cycle, and facilitate better compliance with payer requirements.
3. Enable automation of communication between billing staff and providers regarding required actions for claim resubmission.
4. Improve denial management by automating recurrent notifications, boosting overall healthcare reimbursement efficiency.
Trigger Conditions
1. Automatedly trigger when a claim status in the billing system updates to “Rejected” or “Denied.”
2. Set automation to trigger if a rejected claim remains unresolved for a configurable interval (e.g., 3, 7, 14 days).
3. Initiate upon failure of initial denial follow-up or lack of claim activity in EHR/RCM system.
4. Allow custom rule-based triggers, such as payer-specific windows, CPT/ICD code-specific rejections, or high-value claims.
Platform Variants
1. Twilio SMS
• Feature/Setting: Automate SMS via “Messages API” using event-based triggers; sample config: POST /Messages with phone, body, and status callback URL.
2. SendGrid
• Feature/Setting: Automate reminders via “Mail Send API” with email template and claim data; configure dynamic templates for each claim.
3. Slack
• Feature/Setting: Automate notification using “chat.postMessage” API for billing team channel; map claim info to message text.
4. Microsoft Teams
• Feature/Setting: Automate reminders with “Incoming Webhook” URLs; structure payload with claim details and call-to-resubmit link.
5. PagerDuty
• Feature/Setting: Automate incident creation via “Incidents API”; trigger follow-up ticket for each overdue claim resubmission.
6. Zendesk
• Feature/Setting: Create or update tickets using “Tickets API” automatedly upon claim rejection detection.
7. Salesforce
• Feature/Setting: Automate task creation through “REST API” (`/services/data/vXX.X/sobjects/Task`); assign follow-ups to AR staff.
8. Epic (EHR)
• Feature/Setting: Use “FHIR API” to automate task generation or notes against patient claim encounters.
9. Cerner
• Feature/Setting: Automate flagging or reminders with “PowerChart Message API” upon claim denial events.
10. Google Sheets
• Feature/Setting: Append automation logs or task lists via “Sheets API” for tracking reminders chronologically.
11. Outlook 365
• Feature/Setting: Automate calendar event or email creation using “Microsoft Graph API” upon each claim rejection.
12. Asana
• Feature/Setting: Automate task assignment to billing specialists using “Tasks API” when claim denial is detected.
13. Monday.com
• Feature/Setting: Automate board updates with claim status using “Items API” for visual tracking.
14. HubSpot
• Feature/Setting: Automate email workflows or ticket pipelines for rejected claims using “Workflows API”.
15. Intercom
• Feature/Setting: Automate chat reminders with “Messages API” for internal billing teams.
16. Zoho CRM
• Feature/Setting: Automate task assignment or email via “CRM API” with claim details and urgency tags.
17. DocuSign
• Feature/Setting: Automate e-signature requests for corrected claim documentation using “REST API”.
18. AWS Lambda
• Feature/Setting: Serverless automation — run scripts to trigger reminders via “Invoke API” based on cloud events.
19. Google Cloud Functions
• Feature/Setting: Automate processing and notification workflows using “Cloud Functions API” when claim status data updates.
20. Freshdesk
• Feature/Setting: Automate ticket creation and reminders for each rejected claim using “Tickets API”.
Benefits
1. Automated reminders reduce manual workload and errors in denial follow-up.
2. Automation ensures timely actions, improving claim resolution rates and cash flow.
3. Automating multi-channel reminders increases follow-up visibility for billing and provider staff.
4. Automatedly escalates repeated denials, enabling faster root cause analysis.
5. Supports compliance by automating documentation and audit trails for claim resubmissions.
Denial Management and Follow-Up