Medical billing and claims processing

Step-by-Step Breakdown

Detailed explanation of each automated stage in the workflow.

1. 1

   Trigger

   Patient visit completed

   A patient visit is marked as complete in the EHR system with all charges and diagnoses documented. This triggers the automated billing workflow to begin processing the claim.

   EpicCerner
2. 2

   Action

   Extract billing data automatically

   The system automatically extracts patient demographics, insurance information, procedure codes, diagnosis codes, and charges from the completed visit record. All relevant billing data is compiled for claim generation.

   EpicAthenahealth
3. 3

   Decision

   Validate insurance eligibility

   The workflow checks patient insurance coverage, benefits, copays, and deductibles in real-time. If coverage is invalid or expired, the claim is flagged for manual review.

   AthenahealthKareo
4. 4

   Action

   Generate and submit claim

   A properly formatted insurance claim is automatically generated with all required codes and documentation. The claim is electronically submitted to the appropriate insurance payer.

   KareoDrChrono
5. 5

   Action

   Track claim status

   The system monitors submitted claims for acceptance, rejection, or requests for additional information. Claim status updates are automatically logged and tracked until resolution.

   Practice FusionAthenahealth
6. 6

   Decision

   Process payment or denial

   When the insurance responds, the system processes either payment posting to patient accounts or denial management. Denials trigger appeals workflow while payments update financial records.

   EpicKareo
7. 7

   Output

   Generate billing reports

   Comprehensive billing reports are generated showing processed claims, payment status, outstanding balances, and revenue metrics. Reports are distributed to billing staff and practice management.

   DrChronoPractice Fusion

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