This workflow automates insurance verification and billing for addiction treatment services, reducing manual processing time and ensuring accurate claims submission while maintaining HIPAA compliance.
Patient completes intake forms and provides insurance information in the treatment facility system.
Each node represents an automated step. Connections show how data and decisions move through the workflow.
Detailed explanation of each automated stage in the workflow.
Patient submits insurance details and treatment authorization through the intake portal. System captures insurance ID, group number, and relevant policy information.
System automatically queries insurance provider databases to verify active coverage, benefits, and pre-authorization requirements for addiction treatment services. Real-time eligibility check confirms coverage details.
System determines if insurance covers requested addiction treatment services and whether pre-authorization is required. Routes workflow based on approval status and coverage limitations.
For cases requiring pre-authorization, system automatically creates and submits prior authorization requests with clinical documentation to insurance providers. Tracks submission status and response timelines.
System generates accurate billing claims with appropriate addiction treatment CPT codes and submits to insurance providers electronically. Ensures HIPAA-compliant data transmission and proper documentation.
System tracks claim status, processes insurance payments, and identifies denied claims for review. Automatically updates patient accounts and flags items requiring manual intervention.
System finalizes patient billing records with insurance payments, remaining balances, and generates patient statements. Compliance documentation is archived securely.
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