Patient eligibility checks for special billing programs

Purpose

1.1 Automate patient eligibility checks for special billing programs to streamline verification, reduce manual workload, avoid billing errors, and ensure psychiatry practices receive appropriate reimbursements.
1.2 Automating data extraction, insurance validation, program-specific eligibility, and feedback to staff or patient, minimizing delays in claim processing and maximizing revenue cycle efficiency.

Trigger Conditions

2.1 New patient registration is completed in EHR or patient portal.
2.2 Scheduled psychiatric appointment flagged for billing program eligibility check.
2.3 Updated insurance details submitted by patient.
2.4 Policy or payer database sync highlights eligibility rules changes.

Platform Variants

3.1 Salesforce Health Cloud: Health Cloud API — automate eligibility verification calls for patient records on creation.
3.2 Epic Systems: Epic Open.epic FHIR API — automatically fire eligibility checks for new appointments.
3.3 Cerner: Cerner Millennium API — configure automator to trigger eligibility workflow on patient entry.
3.4 Athenahealth: Athenahealth Patient Eligibility API — automate repeated eligibility queries for specific psychiatry billing codes.
3.5 AdvancedMD: Insurance Eligibility Integration — automate eligibility polling on appointment scheduling.
3.6 Kareo: Kareo API Eligibility Endpoint — automate batch patient checks for Medicaid/Medicare eligibility.
3.7 DrChrono: Insurance Verification API — automated query for every new patient profile.
3.8 Practice Fusion: Automate eligibility via Surescripts Eligibility Service integration.
3.9 NextGen Healthcare: Eligibility Checking API — automate when claims are prepared for psychiatry procedures.
3.10 Allscripts: Payer Eligibility Check API — automatically trigger checks on intake form submission.
3.11 Medisoft: RelayHealth API — automate automated eligibility check routines on billing queue add.
3.12 Greenway Health: Automated payer eligibility lookup via API with scheduler trigger.
3.13 SimplePractice: Zapier integration — automate eligibility check workflow using Zap endpoints.
3.14 Availity: Real-Time Eligibility & Benefits API — automate submission using batch patient data.
3.15 Office Ally: Eligibility API endpoint automation for specialty payers.
3.16 Change Healthcare: API for automating specialty program eligibility verification.
3.17 Emdeon (now Change Healthcare): Automated eligibility clearinghouse feed.
3.18 Health Gorilla: FHIR Eligibility API — automator to submit patient and insurance data.
3.19 Philips IntelliSpace: Custom eligibility automation on patient record updates.
3.20 Redox Engine: Data Model - Eligibility Checks API — automate eligibility validation for psychiatry billing.
3.21 Google Cloud Healthcare API: Automating eligibility check orchestration between EHR and payer data warehouses.
3.22 AWS HealthLake: Automated eligibility rule engine invocation upon new patient upload.

Benefits

4.1 Automates eligibility validation, reducing manual errors.
4.2 Streamlines claims and billing, automating eligibility confirmation for psychiatry cases.
4.3 Accelerates revenue cycles through real-time automated checks.
4.4 Ensures compliance with payer and governmental regulations with automated workflows.
4.5 Frees staff time for higher-value psychiatric patient care, thanks to automation.
4.6 Reduces denials as automator ensures eligibility is confirmed before claims submission.
4.7 Improves patient satisfaction by automatedly preempting billing issues.