Automatically checks patient insurance eligibility before appointments. Queries payer portals, flags issues, and notifies staff of coverage gaps.
Stop spending hours on the phone with insurance companies. This workflow automates insurance eligibility verification by connecting directly to payer portal APIs and clearinghouse services. It runs on a schedule, checking all patients with appointments in the next 72 hours.
For each patient, the bot queries the relevant insurance payer using EDI 270/271 eligibility transactions or direct API calls. It checks active coverage status, deductible amounts, copay requirements, and any authorization needs for the scheduled procedure codes. Results are cached and compared against previous verifications to flag changes.
When issues are detected — lapsed coverage, out-of-network status, missing authorizations — the workflow automatically generates a task for the billing team and optionally sends the patient a heads-up notification. Clean verifications are logged and attached to the appointment record. Most practices save 10+ hours per week on verification calls alone.
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n8nPlatform
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{
"name": "Insurance Verification Bot",
"nodes": [
{
"id": "schedule",
"type": "n8n-nodes-base.scheduleTrigger",
"name": "Daily Verification Run",
"position": [
250,
300
],
"parameters": {
"rule": {
"interval": [
{
"field": "cronExpression",
"expression": "0 6 * * *"
}
]
}
}
},
{
"id": "fetchAppts",
"type": "n8n-nodes-base.httpRequest",
"name": "Get Upcoming Appointments",
"position": [
450,
300
],
"parameters": {
"url": "={{$env.PMS_API_URL}}/appointments",
"method": "GET",
"queryParameters": {
"days_ahead": 3,
"needs_verification": true
}
}
},
{
"id": "loop",
"type": "n8n-nodes-base.splitInBatches",
"name": "Process Each Patient",
"position": [
650,
300
],
"parameters": {
"batchSize": 1
}
... truncated (205 lines total)
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