Billing teams at disability service providers manually extract roster data, verify client eligibility, and cross-check service rates before submitting claims to funders. This repetitive data entry and validation work consumes significant time and introduces errors that delay reimbursement.
Automation reads the weekly roster, validates client eligibility and rates against live databases, calculates claim totals, and generates compliant claim documents ready for submission. Claims are processed the same day the roster closes, with higher accuracy and a complete audit trail.
The full workflow, from trigger to completion.
Automation detects a new roster file in the designated folder or email inbox and begins processing.
Automation reads the roster file and extracts staff names, hours, client IDs, service codes, and rates into a structured format.
Automation queries the client database to confirm each client is active, funded, and eligible for the claimed service code.
Automation cross-references each service code against the funder's rate schedule stored and applies the correct rate.
Automation sums hours and amounts by client and funder, and reconciles the total against the roster.
Automation formats the validated claim data into the funder's required PDF or XML format.
Automation sends the completed claim to the finance manager with a summary of validation results and any flagged issues.
After manager approval, automation submits the claim to the funder via email or secure portal and logs the submission.
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