Insurance & Funding Claims

Clinic management system detects that a patient's treatment episode has been marked complete and no claim has yet been submitted for this episode.

Automation retrieves patient demographics, treatment dates, session count, clinical notes, and cost from the clinic system via API.

Automation looks up the patient's insurance or funding source and retrieves the correct claim form template and submission requirements for that payer.

Automation gathers clinical notes, treatment plans, and progress reports from the clinic system, validates that all required documents are present, and flags any gaps for human review.

Automation fills in the payer's claim form with extracted patient and treatment data, applying payer-specific formatting rules and field mappings.

Automation sends the completed claim and supporting documents to the payer via email or uploads to the payer's online portal, and logs the submission.

Automation monitors claim status by checking payer responses and escalates overdue claims for manual follow-up, with a summary of claim details and expected response date.