With DocStation's powerful AI, a highly streamlined medical billing workflow can be at your fingertips in just a few quick clicks. Check out the automated billing intro article here, and read on for instructions on setting up automations for your organization. Check out this tutorial for a quick how-to, video-style!
Configuring Claims Automation
First, create the necessary claim templates for the desired targeted services.
Automation requires organization-based templates (not DocStation library templates)
Automation requires using Basic Fixed Cost templates
Example: if Org wants to target new opioid therapies, create a new org-based basic fixed cost template called “New Opioid Medication Counsel (automation)”
select applicable parameters
add applicable service code(s) and details
CPT 99212
Value $70
Diagnosis code (something generic is good to start; can be modified before the claim is submitted): R52 Pain, unspecified
Place of service: 01-Office
Create an org-based basic fixed cost template to use for the claims that will be generated.
Include the applicable service code(s), value, diagnosis (if desired), modifiers (if needed), and place of service (if other than Pharmacy).
Next, navigate to Org Settings, Automations tab, + to create a new Automation.
Add a title and description to outline the purpose of the automation.
Select an event (trigger). Currently, “New Medication Prescribed” is the only option. Then select an action. Currently, “Create a claim” is the only option.
Next, configure the rule parameters. Select a filter. Currently, filters include NDC, BIN, and PCN. Use any or all in any combination.
Pro tip: It is best to start with NDCs.
Add the NDCs (and BIN and PCN, if desired) to target in the filter list, one per row, 11-digits. No need to format - the form will format automatically.
Select the template to be used for this Automation. Any eligible templates will show in the dropdown. Save the Automation.
Pro tip: if you navigate away from this screen before saving, the filters will be lost. So be sure to create the template(s) first, as described above.
Once the Automation is configured, activate it for the applicable locations. Select the rule, then Edit will appear. Select Edit, then Edit Locations.
Deleting the automation (or multiple, if more than one is selected) is also available from this menu.
Select a rule to edit the active locations.
Select Edit Locations.
Select the locations for which this Automation should be activated. Any location can have any Automation configuration, and it does not have to match any other location in the organization.
Use the meatball menu to copy or delete an automation. Making a copy of an Automation will save a few configuration steps, depending on how similar or different the rules need to be.
After dispensing data has started flowing, use the History tab on the Automation to verify the Automation is working as expected.
Filtered = the event did not match a rule
Success = the event matched a rule and produced the specified action (a draft claim)
Failed = the event was not properly processed. “Replay” can be helpful to try reprocessing a failed event.
The data can also be reviewed at the patient level. Navigate to the patient’s health record, then the Automations tab.
Other Pro Tips and Best Practices
We totally get that this can feel overwhelming. The sky is the limit here, but it may feel like targeting all the therapeutic classes and various services you provide is just way too big a scope. Consider the following tips and best practices to help keep this industry-leading feature in check.
Lean into Template and Automation titles - be very specific so you know what you're looking at and trying to do.
Good: Immunization Consult Template
Better: Immunization Consult Template (automation; Main Street location)
Categorize automations by drug therapy class or condition - the most likely aspect to vary from template to template is the diagnosis. If you're aiming for the most hands-off experience with automated billing, group your templates and rules by diagnosis code.
For brand new users on DocStation, it is best to configure Automations before enabling dispensing system integrations. This offers the greatest chance for all your data to be evaluated by Automation from the start.
If this doesn't happen, or you're a long-time DocStation partner (thank you!!!), no worries at all. We've got features in place to help review your historical data too.
As always, reach out to a DocStation team member via Chat with any questions!