Billing, Insurance & CompliancePurpose
1.2 Ensure real-time, automated compliance with insurance policy changes and pricing tiers in eyecare billing and invoices.
1.3 Eliminate manual data entry by automating cross-referencing payer contracts, coverage limits, deductibles, and in-network pricing rules with catalog price lists.
1.4 Automator cross-checks updated insurance agreements—automatedly syncing pricing with insurance databases and document management sources.
1.5 Provide audit logs and automated notifications when pricing is changed due to automatable business rules.
Trigger Conditions
2.2 Insurance API or portal posts new contract details or pricing rules.
2.3 Scheduled review (e.g., nightly, weekly) of active insurance partner agreements.
2.4 Automated billing software polls for new notices from insurance clearinghouses.
Platform Variants
• API: Insurance Policy Object, Pricebook2 Object—automate updates when insurance coverage records change.
3.2 Epic Systems
• Feature: Integration with Contract Management module—automated rule scripts update procedure codes’ prices.
3.3 Athenahealth
• API: Insurance/Contract API; automate price updates when payer policies change.
3.4 Cerner
• Integration: HealtheIntent Data API—automated data flows for pricing synch based on insurance updates.
3.5 NextGen Healthcare
• API: Contracts Endpoint; automate retrieval and automatedly map coverage to item prices.
3.6 AdvancedMD
• Insurance Management module—configure automation to update fee schedules automatically.
3.7 CooperVision LensFerry
• Feature: Automated catalog price synch from insurer feeds, triggered by new agreements.
3.8 RevolutionEHR
• Setting: Insurance Pricing Updater—automated upload of payer fee schedules to services.
3.9 Practice Fusion
• Feature/API: Automated Fee Schedule Import—automates pricing updates with payer data files.
3.10 DrChrono
• Integration: Automated EDI Sync—automatedly updates item prices on new insurer coverage terms.
3.11 VSP Global Provider Portal
• Feature: Automated EOB and contract notice webhook—trigger price updates in connected EHR.
3.12 Eyefinity
• App: Fee Schedule Automation—schedules downloads and updates internal pricing lists.
3.13 SAP Health
• Module: Pricing Automation in Master Data; triggers automated pricing table changes.
3.14 Microsoft Power Automate
• Trigger: Automated download of insurer document from SharePoint; parse and push changes to financial system.
3.15 Zapier
• App: Insurance PDF Parser—automated text extraction, parser, and webhook for scheduling fee updates.
3.16 UiPath
• Workflow: Automated data extraction from payer emails—updates pricing in billing software.
3.17 MuleSoft
• Endpoint: Insurance Policy Change Listener—routes data to EHR/practice systems for automated updates.
3.18 AWS Lambda
• Function: Event-driven automated parsing of insurance S3 data—auto-invokes pricing job.
3.19 Google Cloud Functions
• Function: Automated ingest and mapping of insurer data to Firestore, then pushes price updates.
3.20 Workato
• Automation: Trigger on insurance pricing CSV upload, transform, sync to pricing database.
3.21 Oracle Health Insurance
• Rule Engine: Automated API for propagating contract rate changes into claim/pricing systems.
3.22 Medinformatix
• Feature: Automated Price Schedule Import—schedules and applies contract updates to services.
Benefits
4.2 Automatedly maintains billing compliance with dynamic insurance terms, reducing audit risk.
4.3 Increases revenue accuracy through automation of complex contract-driven price rules.
4.4 Automated alerts and logs improve transparency and traceability for all pricing changes.
4.5 Frees staff for patient-facing tasks by automating repetitive administrative workflows.