Problem Statement

Credit balances must be reviewed and resolved through refund or adjustment within payer and regulatory timeframes, and working them manually is slow; unresolved credits inflate Net Days in Credit Balance and create compliance exposure. Many insurance credits resolve to a refund owed back to the payer, but the refund can't simply be issued: each credit has to be identified, routed for review and approval, and then processed once cleared. Moving each one through that review-and-approval path manually is slow, and credits awaiting refund sit on the books inflating the credit balance the whole time.

Automation Solution

This automation identifies Epic transactions with insurance credits, routes them for refund review, and processes the refund once approved to clear the credit balance.