Workflow automation for healthcare revenue cycle operations.
From eligibility verification to remittance reconciliation — claim submission, denial management, and payment posting running as a single automated pipeline inside your infrastructure.
Book a claims demoRevenue cycle operations are among the most labor-intensive workflows in healthcare. Eligibility must be verified before every visit. Claims must be coded correctly for dozens of payers with different rules. Denials must be analyzed, appealed, and tracked manually by billing staff who are already stretched thin.
SmartFlowCraft structures the revenue cycle as a configurable workflow. Eligibility, coding validation, claim submission, and denial management run automatically. Staff focus on exceptions, not routine processing — and all of it runs inside your cloud.
Submission to reconciliation.
Eligibility verification
Real-time eligibility checks run at scheduling and again at check-in. Coverage details, deductibles, and co-pay amounts surfaced before the visit.
Claim coding validation
ICD-10, CPT, and modifier combinations validated against payer-specific rules before submission. Coding errors flagged before they become denials.
Claim submission
Claims routed to payers via your clearinghouse. Submission confirmations tracked. Failed transmissions automatically requeued with error annotations.
Status tracking
Real-time claim status pulled from payer portals and clearinghouse feeds. Pended claims flagged. Expected payment timelines tracked automatically.
Denial management
Denied claims analyzed for root cause. Common denial patterns surfaced as workflow rules. Appeals drafted and resubmitted on a configurable schedule.
Remittance processing
ERA files ingested and reconciled against submitted claims. Payment posting, adjustment codes, and balance notifications handled without manual review.
Eligibility to payment.
Patient eligibility verified at scheduling and check-in
Encounter documented → ICD-10 and CPT codes assigned
Claim coding validated against payer-specific rules
Clean claim submitted to payer via clearinghouse
Claim status tracked — pended or denied claims flagged
Denial root cause identified → appeal drafted automaticallySmartFlowCraft
ERA received → remittance reconciled and payment posted
Outstanding balances and collection triggers managed