Automate your healthcare billing from patient intake to payment

Moves a patient's claim from intake through insurance checks, coding, submission, and payment with less manual work.

How the work actually flows

It branches. Exactly one path is taken.

Pattern: Sequence (1) · Exclusive Choice (4)

flowchart TD trig(["scheduled patient processing run"]):::trigtime s0["check insurance eligibility"]:::task s1["assign codes and validate claim"]:::task s2["submit claim to payer"]:::svc s3["receive payer response"]:::task trig --> s0 s0 --> s1 s1 --> s2 s2 --> s3 gx{"× claim approved or denied"}:::gate s3 --> gx p00["route for correction"]:::task gx -->|"denied"| p00 p10["post payment and send statement"]:::task gx -->|"approved"| p10 p00 --> out p10 --> out out[/"claim resolved or corrected"/]:::out pay{{"faster reimbursement fewer errors"}}:::pay out --> pay s2 -. "failures recorded, run continues" .-> out classDef task fill:#e7f6fe,stroke:#34b8f0,color:#2c2a29 classDef svc fill:#f6f8fa,stroke:#7c8795,color:#2c2a29 classDef mi fill:#e7f6fe,stroke:#0079a8,color:#2c2a29,stroke-width:2px classDef human fill:#fff,stroke:#0079a8,color:#0079a8 classDef store fill:#f6f8fa,stroke:#0079a8,color:#2c2a29 classDef trig fill:#00a4eb,stroke:#0079a8,color:#fff,font-weight:bold classDef trigtime fill:#00a4eb,stroke:#0079a8,color:#fff,font-weight:bold classDef trigdata fill:#8ad4f5,stroke:#0079a8,color:#06314c,font-weight:bold classDef gate fill:#fff,stroke:#e8a23d,color:#6b4708,font-weight:bold classDef out fill:#1f9d6b,stroke:#167a53,color:#fff,font-weight:bold classDef pay fill:#06314c,stroke:#021f33,color:#fff
Starts itA stepAn outside serviceOne path onlyResultPayoff
Build size
Advanced

A larger build with multiple systems, AI reasoning, and custom rules.

Business functions
General Automation
Connects
EHRClearinghouse
Featured in

The problem it solves

Your billing team spends hours checking insurance eligibility, coding claims correctly, submitting them, and then chasing denials that could have been avoided. Every manual step is a chance for a costly mistake or a delayed payment.

Who it fits

Healthcare practices and billing teams managing patient claims and revenue cycle work.

How it works

  1. Runs automatically on a set schedule to process new patients
  2. Checks insurance eligibility and pulls clinical documentation
  3. Assigns medical codes and validates the claim against payer rules
  4. Submits the claim and waits for the payer's response
  5. Routes denied claims for correction or posts approved payments and sends the patient a statement
What you get

Claims moved further along before anyone touches them

You get patient claims checked, coded, and submitted automatically, with anything unusual routed to your team for a final look.

What you get

A submitted, tracked insurance claim that ends in a posted payment or a routed correction, plus a patient statement when needed.

What you need

Access to your EHR system, a clearinghouse account, and payer system credentials.

We can build this. But should you?

The hard question is not how to build it. It is whether this is the right thing to build first.

That is what a Fractional Chief AI Officer figures out with you, before anyone writes a line of code.

Let's Talk Strategy

Related automations

Calculate shopping cart totals and apply discounts automatically

Automatically totals each shopping cart and applies a discount when the order is large enough.

Standard

Get alerted in Microsoft Teams when a site goes offline

Checks your Unifi network sites on a schedule and posts a Microsoft Teams alert the moment one drops offline.

Standard

Shorten long URLs automatically with a custom domain

Turns any long web link into a short, branded URL using your own custom domain in seconds.

Standard

Write personalized LinkedIn connection notes with AI

Reads each prospect's LinkedIn profile and uses AI to write a personalized connection request message.

Advanced
Back to the AI Playbook