Seamless claims submission to insurance providers

Purpose

1.1. Automate the seamless claims submission to insurance providers for ENT/Otolaryngology practices to ensure rapid, error-free processing and reduced manual intervention.
1.2. Automates the end-to-end process from encounter completion to claim submission, tracking, and payment reconciliation for otolaryngology billing operations.
1.3. Enables medical practitioners to automate data extraction from EHR/EMR, validation, claim creation, and secure transfer to insurers, minimizing denials and administrative delays.
1.4. Improves compliance by automating adherence to payer-specific requirements and automating real-time eligibility verifications for ENT-specific procedures.

Trigger Conditions

2.1. Patient encounter completion entered in EMR/EHR.
2.2. Diagnostic/procedural coding finalized within billing system.
2.3. New charges or superbills generated in the ENT clinic’s practice management system.
2.4. Scheduled daily/weekly batch submission time reached for claims automation.
2.5. Receipt of lab/pathology results triggering secondary claim creation.

Platform Variants

3.1. Athenahealth
- Feature: API Claim Submission
- Config: Automate claim payload assembly via POST to /claims endpoint.

3.2. Kareo
- Feature: Claims API
- Config: Automate claims JSON object to Claims.Submit endpoint.

3.3. AdvancedMD
- Feature: Claims Transmission
- Config: Automate HL7 X12 837 electronic file submission via Secure FTP/API.

3.4. DrChrono
- Feature: Insurance Claim API
- Config: Automate POST to /claims API with mapped ENT CPT, ICD-10 codes.

3.5. NextGen Healthcare
- Feature: Claims Automation Module
- Config: Automate EDI 837 claims export and upload direct to payer portal/API.

3.6. PracticeSuite
- Feature: Claims Submission Integration
- Config: Automate claims file batching and SFTP transmission to clearinghouses.

3.7. eClinicalWorks
- Feature: Claims Cloud API
- Config: Automate claim data POST to /claims/submit.

3.8. Allscripts
- Feature: PM Claim Submission
- Config: Automate XML/837P file upload through REST API.

3.9. Cerner
- Feature: HealtheIntent Claim Automation
- Config: Automate data mapping from clinical record to payer API.

3.10. Epic
- Feature: Billing Claims API
- Config: Automate launching claims submission on patient checkout.

3.11. Greenway Health
- Feature: Intergy Claim Automation
- Config: Automate direct payer transmission with custom rule triggers.

3.12. Medisoft
- Feature: Batch Automation
- Config: Automate claim export and upload via third-party connector.

3.13. Availity
- Feature: Clearinghouse API
- Config: Automate claim POST to /claimsubmission endpoint.

3.14. Change Healthcare
- Feature: Claims Gateway Integration
- Config: Automate X12 837 uploads and get automated claim status.

3.15. Office Ally
- Feature: SFTP Claims Interface
- Config: Automate file drop for claim ingestion.

3.16. Waystar
- Feature: Automated Claims Submission
- Config: Automate REST API integration for 837 transmission.

3.17. InstaMed
- Feature: Healthcare Claims API
- Config: Automate automated claim data posting to payer API.

3.18. OpenEMR
- Feature: X12 837 Submission
- Config: Automate claim file generation and SFTP push.

3.19. Meditech
- Feature: Revenue Cycle Automation
- Config: Automate claim batch creation and secure submission.

3.20. Zirmed
- Feature: Claims Automation Suite
- Config: Automate file transfer of claims via secure API endpoint.

Benefits

4.1. Automates error-checking and eliminates manual data entry in claims workflows.
4.2. Automating the submission reduces claim denials and improves cash flow for ENT practices.
4.3. Automation ensures fast, traceable, and compliant submissions across insurers.
4.4. The automator centralizes monitoring for claim statuses and automates follow-up reminders.
4.5. Automates matching remittance advice to submitted claims for accelerated reconciliation.
4.6. Automatically adapts to insurance policy changes, making the claims process reliably automatable and scalable.