Problem Statement

Coverage and benefit details must be confirmed and entered accurately before billing, and doing this manually at volume is slow and error-prone. A newborn's coverage is often not created or active at the time of the stay, so the baby's claim can't be billed until eligibility confirms the new member has been added under the guarantor's plan. Gaps like these incorrectly create self-pay balances and avoidable rework.

Automation Solution

This automation runs eligibility to confirm newborn coverage has been created and is active, then updates coverage details in Epic and releases the claim.