Billing and claims processing

Step-by-Step Breakdown

Detailed explanation of each automated stage in the workflow.

1. 1

   Trigger

   Visit completion detected

   The workflow initiates when a dermatology patient visit status changes to 'completed' in the EHR. This automatically pulls all visit data including procedures, diagnoses, and patient demographics.

   Epic EHRModernizing Medicine EMA
2. 2

   Action

   Extract billing codes automatically

   System retrieves CPT codes for dermatology procedures, ICD-10 diagnosis codes, and validates coding accuracy against documented services. Special attention to dermatology-specific procedures like biopsies, excisions, and cosmetic treatments.

   Epic EHRModernizing Medicine EMA
3. 3

   Action

   Verify insurance eligibility

   Automatically checks patient's insurance coverage, benefits, deductibles, and prior authorization requirements. Validates coverage for specific dermatology services performed.

   Epic EHR
4. 4

   Decision

   Determine claim submission path

   Evaluates if claim meets auto-submission criteria or requires manual review based on complexity, prior authorization status, or coding accuracy confidence scores.

   Epic EHR
5. 5

   Action

   Generate and submit claims

   Creates clean claims with proper dermatology billing codes and submits electronically to insurance payers. Handles both medical and cosmetic procedure billing appropriately.

   Epic EHRModernizing Medicine EMA
6. 6

   Action

   Track claim status automatically

   Monitors claim processing status, identifies rejections or denials, and automatically resubmits corrected claims when possible. Flags complex issues for staff review.

   Epic EHR
7. 7

   Output

   Post payments and reconcile

   Automatically posts insurance payments and patient responsibility amounts to accounts. Generates patient statements for outstanding balances and updates financial reporting dashboards.

   Epic EHRModernizing Medicine EMA

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