Insurance Workflows
Check a patient's coverage, confirm benefits, and move claims between providers and payers — automatically.
About Insurance
Before care happens, someone has to answer two questions: is the patient covered, and what will they owe? Insurance eligibility and benefits verification (EVBV) answers them — and it's one of the most repetitive, error-prone jobs in any practice.
These workflows automate it. Triggered by a booking or an API call, they pull the patient's insurance details, send a real-time eligibility request to the payer through Stedi, and turn the response into a clear report of coverage, copays, deductibles, and what's covered.
What you can do
- Real-time eligibility & benefits checks (X12 270/271) via Stedi
- Triggered automatically from HL7 appointment messages or a simple API call
- Plain-English coverage reports — plan status, copays, deductibles, out-of-pocket
- Catch coverage problems before the visit, not after a denied claim
Requirements
Set up these connections in the Workflow Builder before running any workflow in this category.
Clearinghouse Connection
A connection to an X12 clearinghouse (Stedi, Change Healthcare, etc.) that routes 270 eligibility requests to payers and returns the 271 response in real time.
EHR Connection
Used to read patient demographics — name, date of birth, member ID — needed to build the eligibility request. Also receives HL7 SIU messages in appointment-triggered flows.
Workflows
2 ready-to-use workflows — open any to see the full flow and download it.
Real-Time Insurance Eligibility & Benefits Checks
Check a patient's insurance eligibility and benefits in real time the moment an appointment is booked — and hand back a clear coverage report.
AI Patient Intake with Built-In Eligibility Check
An AI agent collects patient intake details in plain language, then runs a real-time insurance eligibility check through Stedi before check-in.