AI workflows for medical billing and insurance claims.

Getting paid for care: prior authorizations, claims, denials and the statements patients receive.

Who does this work

  • Medical biller
  • Claims specialist
  • Revenue cycle manager

2 workflow templates ready to adapt, and 3 workflows identified.

Updated

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Examples of the workflows identified
  1. Compare a patient statement with the explanation of benefits
  2. Work the insurance claim denial list
  3. Assemble a prior authorization review packetIllustrative

The workflows identified

Marked illustrative: an example of the work, identified, with no workflow template yet.

Compare a patient statement with the explanation of benefitsGives the billing office a service-line comparison of patient statement and payer explanation of benefits, with unmatched amounts and a draft inquiry.Workflow templateWork the insurance claim denial listGives the billing team a denial work list sorted by deadline and amount, with stated reasons, missing support and follow-up tasks.Workflow template
Assemble a prior authorization review packetGives the authorization team a packet index linking the payer's requirements to available documents, with unresolved questions.Illustrative · not built yet

Workflow templates

Claim denial work listThe billing coordinator gets every denied claim from the practice’s remittance export on one work list, sorted by kind of denial, appeal deadline and amount, with the paperwork each one needs and a short summary of where denials keep starting. Staff decide every appeal.Workflow templatePatient statement and explanation of benefits comparisonA billing specialist answering a patient’s question gets the statement and the insurer’s explanation of benefits compared line by line by service date, every unmatched amount traced to its page, and a plain-language reply drafted for approval. Nothing on the account changes.Workflow template

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Where to go next

All of billing, receivables and collectionsThe broader area this belongs to, with its workflows.All of finance and accountingEvery area of the function, with workflow templates and examples.Map your team in the PlannerPut this work in your plan, with the roles that do it.

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