Funding & Claims Management

Practice management system flags a patient as discharged after completing an eligible treatment episode. The automation platform receives the trigger with patient ID, treatment dates, and service codes.

The automation queries the eligibility matrix (stored) against patient treatment codes and location to determine which funding schemes apply.

The automation fetches treatment notes, invoices, and consent forms from the practice management system and any linked cloud storage.

The automation fills the appropriate funding scheme form template with patient details, treatment dates, costs, and practitioner credentials, then generates a PDF.

The completed form and supporting documents are submitted via email or API to the funding provider, with a confirmation record created.

Claim details, submission date, expected response date, and scheme reference are recorded and synced for revenue tracking.

The automation checks provider portals and email weekly for status updates, and sends an alert to the practice manager if a claim exceeds its expected response window.

When a response is received, the automation logs the approval status and amount and, and flags the claim for payment reconciliation.