Billing and claims submission

Step-by-Step Breakdown

Detailed explanation of each automated stage in the workflow.

1. 1

   Trigger

   Treatment completion recorded

   Patient treatment is marked as completed in the practice management system. This automatically initiates the billing and claims submission process.

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2. 2

   Action

   Generate insurance claim

   System automatically creates an insurance claim using treatment codes, patient information, and insurance details. Claim is populated with appropriate CDT codes and fee schedules.

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3. 3

   Action

   Verify insurance eligibility

   Real-time verification of patient's current insurance coverage and benefits to ensure claim accuracy. Checks for coverage limits, deductibles, and pre-authorization requirements.

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4. 4

   Decision

   Check claim validation

   Automated validation checks claim for completeness, correct coding, and potential rejections. Routes to manual review if errors are detected, otherwise proceeds to submission.

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5. 5

   Action

   Submit electronic claim

   Electronically submits validated claim to insurance carrier via clearinghouse. Generates claim tracking number and submission confirmation.

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6. 6

   Action

   Track claim status

   Monitors claim processing status and automatically follows up on delayed payments. Sets reminders for claim follow-up based on typical processing timeframes.

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7. 7

   Output

   Update payment records

   Posts insurance payments to patient accounts and generates patient statements for remaining balances. Creates aging reports for outstanding claims requiring attention.

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