Insurance and funding claims require staff to manually extract patient data, identify the correct payer form, compile supporting documents, and complete claim submissions. This process is time-consuming and error-prone, with incomplete claims causing delays in reimbursement.
Automation extracts patient and treatment data directly from clinic records, populates the correct claim form for each payer, and submits claims via email or portal.
The full workflow, from trigger to completion.
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.
No credit card, no commitment. Map your process and walk away with a full build plan.
A visual process map, automation spec, delivery timelines, and everything needed to build it, customized to your workflow and tools.
Custom pricing, ROI projection, and payback timeline based on your actual process, not industry averages.
Your build plan stays in your workspace with no expiry. Move forward whenever the timing is right.
Other high-impact processes teams commonly map alongside this one.
Everything you need to know before mapping this process.
Map this to your business to get your exact numbers.
Map This AutomationNo credit card required — it's free.