Problem Statement

Authorizations must be resolved before service, and doing it manually is labor-intensive. When a 278R electronic response comes back, the approval has to be validated against the correct service, the appropriate billable CPTs added, and the record checked for duplicates or errors before it can be released to bill. Across multiple payers with their own response quirks (BCBS, Tufts, HPHC), this post-approval reconciliation is detailed, rules-heavy work, and a wrong or missing CPT, or a duplicate left in place, will cause downstream denials.

Automation Solution

This automation validates post-278R authorization approvals from BCBS, Tufts, and HPHC, adds corresponding billable CPTs, checks for duplicates or errors, and releases the account from the workqueue.