Billing & Insurance ProcessingPurpose
1.2. Automates intake of rejection notices, collects required resubmission data, accelerates document collation, and resends claims with new attachments, following payer protocols.
1.3. Automates cross-checking rejections against payer-specific rules, streamlines communication with billing teams, escalates non-compliance, and catalogs resubmissions for audit and tracking.
1.4. Ensures compliance, improves cash flow, reduces revenue leak, and automates analytics/reporting for management.
Trigger Conditions
2.2. Manual flagging by billing staff in EHR or RCM.
2.3. Automated schedule (e.g., daily/weekly scans of new denials).
Platform Variants
3.1. Twilio
• Feature/Setting: SMS API; auto-notification on claim rejection or successful resubmission.
• Sample: Configure webhook to send SMS to billing supervisor on key events.
3.2. SendGrid
• Feature/Setting: Mail Send API; automate resubmission confirmation emails to billing and management.
• Sample: Setup automated templates for “Resubmitted Claim” events.
3.3. DocuSign
• Feature/Setting: eSignature API; automate requests for missing patient/provider signatures on resubmitted claims.
• Sample: Conditional triggers from workflow to send signature packets.
3.4. Salesforce Health Cloud
• Feature/Setting: Workflow Rules/Process Builder; auto-task creation and claim status tracking.
• Sample: On “Rejected Claim” field update, trigger “Resubmission” workflow.
3.5. Google Sheets
• Feature/Setting: Apps Script/Triggers; log all claim rejections and automated resubmission status updates.
• Sample: Script updates cell when status changes in connected EHR.
3.6. Microsoft Power Automate
• Feature/Setting: Automated Flows; automate EHR-payer data transfer on rejection.
• Sample: Design “When email received” flow, parse rejection, and auto-initiate resubmission.
3.7. Zapier
• Feature/Setting: Multi-step Zaps; automate copying claim details from rejection notices into billing system.
• Sample: Zap triggers on Gmail, sends data to EHR.
3.8. Slack
• Feature/Setting: Incoming Webhooks/API; automated claim rejection/resubmission alerts to billing channel.
• Sample: Post message when a claim moves to “Resubmitted” status.
3.9. Box
• Feature/Setting: File Request API; automate collection of supporting documentation for claims.
• Sample: Auto-generate folders and share links with staff.
3.10. AWS S3
• Feature/Setting: S3 Event Triggers; archive supporting files for resubmissions automatically.
• Sample: Trigger on file upload to push to long-term claim archive.
3.11. Workato
• Feature/Setting: Recipes for EHR-to-payer system automation; parse denials, automate follow-ups.
• Sample: Recipe scans incoming payer messages, kicks off resubmission.
3.12. Medisoft
• Feature/Setting: API/Webhooks; automate claim data extraction and status updates.
• Sample: Webhook posts “rejected” claims to resubmission queue.
3.13. Athenahealth
• Feature/Setting: Open APIs; automate denied claim retrieval and payload dispatch for resubmission.
• Sample: Workflow polls for “Denied” status, sends via FHIR.
3.14. QuickBooks
• Feature/Setting: Accounting API; automate write-back of re-submitted claim payment status.
• Sample: Update accounts receivable on resubmission.
3.15. HubSpot
• Feature/Setting: Workflows/CRM API; automate creation of deal tickets per claim and auto-update on status.
• Sample: Pipeline moves “Rejected” to “Resubmitted” stage.
3.16. Trello
• Feature/Setting: Cards & API; each claim as card, automated moves/resubmission triggers.
• Sample: Rule moves card to “Resubmitted” list on trigger.
3.17. Asana
• Feature/Setting: Rules/Integrations; automated task assignment for claim follow-up.
• Sample: On “Rejection” status, auto-task assigned to billing.
3.18. Google Drive
• Feature/Setting: API/Triggers; automated claim document storage and retrieval workflows.
• Sample: Files on resubmission automatically organized in folders.
3.19. PagerDuty
• Feature/Setting: Incident APIs; automate escalation when claim not resubmitted by SLA threshold.
• Sample: Incident triggered for time-out cases.
3.20. monday.com
• Feature/Setting: Automations; claim rejections logged, automating board item creation for billing.
• Sample: Trigger auto-item creation on new claim rejection.
3.21. Smartsheet
• Feature/Setting: Automated Workflows; claim status and notes updated after each automation step.
• Sample: Automatically change row status to “Resubmitted”.
3.22. Freshdesk
• Feature/Setting: Ticketing API; rejection automatically opens ticket for billing team; resubmission triggers closure.
• Sample: Integrate claim status tracker with ticket auto-closure.
Benefits
4.2. Automates documentation collection and escalates exceptions for timely intervention.
4.3. Enables full audit trails through integration, enhancing compliance and transparency.
4.4. Automates communication for status updates, increasing team efficiency and patient satisfaction.
4.5. Reduces accounts receivable days and enables automated analytics for revenue leakage.