Insurance verification and billing

Step-by-Step Breakdown

Detailed explanation of each automated stage in the workflow.

1. 1

   Trigger

   Patient procedure scheduled

   A cosmetic surgery procedure is scheduled in the practice management system, triggering the insurance verification workflow.

   SymplastNextTech EMR
2. 2

   Action

   Extract patient insurance data

   Retrieves patient insurance information, policy details, and procedure codes from the electronic health record system.

   Epic EHRModMed Plastic Surgery
3. 3

   Action

   Verify insurance eligibility

   Automatically checks insurance coverage, benefits, deductibles, and co-pays through real-time eligibility verification services.

   SymplastEpic EHR
4. 4

   Decision

   Evaluate coverage requirements

   Determines if the procedure requires pre-authorization or if it's considered cosmetic versus reconstructive based on insurance policy rules.

   NextTech EMRModMed Plastic Surgery
5. 5

   Action

   Submit pre-authorization request

   Automatically generates and submits prior authorization requests with medical documentation for procedures requiring approval.

   Cerner PowerChartSymplast
6. 6

   Action

   Generate billing documentation

   Creates accurate billing codes, claim forms, and supporting documentation based on procedure details and insurance requirements.

   ModMed Plastic SurgeryEpic EHR
7. 7

   Output

   Deliver verification summary

   Provides comprehensive insurance verification report with coverage details, authorization status, and patient financial responsibility to billing team.

   SymplastNextTech EMR

Related Cosmetic Surgery Articles