Billing, Payments, and ClaimsPurpose
1.2. Streamline claim authorization, eligibility evaluation, and error detection to reduce manual intervention and payment delays.
1.3. Provide end-to-end automating workflows for reviewing claim data, validating coverage, checking ICD/CPT codes, and compliance cross-checking.
1.4. Increase accuracy, mitigate fraud risks, and automate documentation required for successful claims processing in the maternity care industry.
Trigger Conditions
2.2. Manual upload or email receipt of claim form or EDI file.
2.3. Trigger upon EHR system marking a visit as billable.
2.4. Automated re-verification when a claim is updated or patient data changes.
2.5. Batch triggers for periodic review of pending or flagged claims.
Platform Variants
• Feature/Setting: API integration with Claim Status API; automatedly retrieve claim statuses and trigger insurance verification upon claim creation.
3.2. Cerner
• Feature/Setting: PowerChart Clinical API for automating extraction and verification of midwifery encounter data and claim coding.
3.3. Athenahealth
• Feature/Setting: "Claims API" for automating submission, status check, and notification of errors in maternity claims.
3.4. AdvancedMD
• Feature/Setting: Automated Claims Manager tool to automate insurance eligibility verification and claim status checks.
3.5. McKesson RelayHealth
• Feature/Setting: Claims Management API for automated batch verification with payers, automating error alert generation.
3.6. Availity
• Feature/Setting: Real-time Eligibility and Claims Status API for automating claims tracking and eligibility checks.
3.7. Change Healthcare
• Feature/Setting: Claim Status API to automate inquiry and verification of submitted maternity claims.
3.8. Kareo
• Feature/Setting: Automated Claims Tracking for real-time, automated status updates and issue detection in midwife claims.
3.9. NextGen Healthcare
• Feature/Setting: Claims Management API, automates claims scrubbing and payor rules compliance checks.
3.10. PracticeSuite
• Feature/Setting: Automated Claims Submission and Verification API for eligibility pre-check and claim status automation.
3.11. Medisoft
• Feature/Setting: Integrated Eligibility Check automation for instant verification before claims submission.
3.12. eClinicalWorks
• Feature/Setting: Claims & Eligibility Web Services; automate pulling patient eligibility and claim approval status.
3.13. Office Ally
• Feature/Setting: EHR/PM <-> Clearinghouse Interface automation for real-time claims status feedback.
3.14. EZClaim
• Feature/Setting: Automated Claims Verification with payer integration for Medicaid/MCO maternity programs.
3.15. HealthFusion MediTouch
• Feature/Setting: Automated eligibility verification via payer API and real-time claim tracking.
3.16. Dentrix
• Feature/Setting: Used in dental/maternity cross-specialty practices; automate insurance eligibility confirmation through eClaims.
3.17. Zirmed (Waystar)
• Feature/Setting: Automated claim monitoring and secondary automation for denied maternity care claims.
3.18. Experian Health
• Feature/Setting: Coverage Discovery API to automate insurance discovery and eligibility check pre-claim.
3.19. Greenway Health
• Feature/Setting: API for automating payer connection and real-time maternity claim verification in EHR.
3.20. Allscripts
• Feature/Setting: Practice Management Interface enables automation of claim eligibility and approval workflows.
3.21. Salesforce Health Cloud
• Feature/Setting: Process Builder for automating insurance claim record review and claim verification triggers via connected APIs.
Benefits
4.2. Dramatically reduces manual data entry, errors, and follow-up workload through automation.
4.3. Automates detection and flagging of common claim issues for faster resolution.
4.4. Improves accuracy, payment cycle time, and compliance with payer rules in the maternity care segment.
4.5. Supports scalable, automatable, end-to-end workflows for midwife billing and claims departments.