Claim submission to insurance and status tracking automated

Purpose

1. Automate claim submission to insurance providers and automated status tracking, enabling pediatric surgeons to expedite reimbursements and automate verification while reducing manual intervention.

2. Automated claim data extraction from EHR, attaching codes, patient details, and documents for seamless upload to payers’ portals.

3. User notification and automated claim status update for finance and billing teams, with rapid escalation for denials or bottlenecks.

4. Automating repetitive billing and insurance tasks to increase compliance, reduce human error, and speed up the payment lifecycle.

Trigger Conditions

1. Patient discharge or completion of procedure recorded in EHR or practice management software.

2. New claim file generated with complete documentation.

3. Scheduled batch trigger (e.g., hourly, daily) for claims automation.

4. Receipt of claim status update or response from payer portal/API.

Platform Variants

1. Athenahealth

• API: Claims API — automate new claim submission and status pulls using patient and procedure fields
  

2. AdvancedMD

• Function: Claims Module Submit API — configure endpoint to automate claim filing upon discharge
  

3. Epic

• API: Revenue Cycle – Claims Submission; set up webhook for claims automation and auto-reconciliation
  

4. Kareo

• API: Submit Electronic Claim, auto-log status updates into billing dashboard
  

5. Greenway Health

• Feature: Claims Manager API — automate EHR-billing sync, automated claim status polling
  

6. NextGen Healthcare

• API: Electronic Claims API endpoint for claim creation and automated status retrieval
  

7. PracticeSuite

• Module: E-Claim Automation Workflow — configure automated triggers at patient checkout
  

8. Cerner

• Function: Claims Management API — automate claim file generation and transmission
  

9. Availity

• API: Provider Portal Integration, automate claim data upload and status fetch
  

10. Change Healthcare

• API: Claims & Remittance Management, automate claim "Create Claim" and "Get Claim Status" endpoints
  

11. Office Ally

• Feature: Claims Submission Batch Import, schedule automated file uploads and status checks
  

12. Emdeon

• API: EDI 837 Claims Automation and automated 277 Status Acknowledgement parsing
  

13. Meditech

• Feature: Claims Management API — configure to automate claim submission from billing module
  

14. DocuSign

• API: eSignature Automation, automate attaching e-signed claim documents before submission
  

15. Box

• Feature: New file in Folder Trigger — automate claim PDFs upload to payer portal
  

16. Gmail

• API: Auto-forward received EOB/claim update emails to automate parsing and trigger status update workflows
  

17. Slack

• Feature: Webhook Notification, automate real-time posting of claim status alerts to billing channels
  

18. Microsoft Teams

• API: Channel Message Posting, automate status alert delivery for claim denials/escalations
  

19. Salesforce Health Cloud

• API: Automated Claims Management Wizard — sync EHR discharge data to trigger automated claim creation
  

20. Google Sheets

• Feature: Automated AppScript, trigger claim data insert to sheet & sync for audit trails
  

Benefits

1. Automator removes repetitive data entry and claim status follow-ups for staff.

2. Automated claims submission accelerates revenue cycle and enables faster reimbursement.

3. Automated status tracking reduces claim denials and outstanding AR by enabling faster intervention.

4. Automation ensures compliance with payer requirements, reducing human error and resubmission rates.

5. Automated notifications keep finance and billing in sync, reducing communication lags.

6. Automatable process supports scalability for high-volume pediatric surgical practices.