Rehabilitation with third-party payers
Claim number, date of the event, prescription: the receptionist captures those three before slotting the assessment, because an incomplete file delays payment far more than it delays the session.
Files and third-party payers
Documents requested, received and missing in one place, and an authorization's expiry visible before the session instead of after the payment is refused.
7 days, 20 answered calls, no card
The task it takes over
A workers' compensation, auto insurance or private insurer episode rarely falls apart on the care itself. It falls apart on a missing document, on an authorization that ran out between the booking and the session, or on one session beyond the number approved.
This add-on opens an administrative episode with its payer, its file number and its authorizations. It asks for the documents, records what arrives, reads it, and keeps the list of what is still missing: prescription, referral, the payer's own form, imaging already done.
From there it watches expiry dates and approved session counts, prepares submissions to the payer, and tells you where each one stands. It settles nothing: eligibility belongs to the organization, the report is signed by the clinician, and transmission runs on the clinic's official channel.
Step by step
- Open
One episode, one payer, one file number
Work injury, road accident, private insurer, a colleague's referral: each case has its payer, its file number and its authorizations. They are captured during the call, along with the date of the event, rather than rebuilt later from a sticky note.
- Collect
The list of what is missing
Medical prescription, the payer's form, the referral received, imaging already done: a checklist separates what arrived from what is outstanding. Documents received are read and attached to the right episode, not dropped into a shared folder.
- Watch
Expiry dates and approved session counts
An authorization has an end date and a number of sessions. The add-on tracks both and warns ahead of the session concerned, so the clinic can clear it up with the patient instead of finding out at billing time, a month later.
- Submit
Prepared here, sent on your official channel
The submission to the payer is prepared, checked and followed to its real status, refusals included. It goes out on the official channel the clinic already uses: Zenvox does not invent a transmission route into a public body.
An add-on, not a base capability
The Health and care base receives the administrative request, identifies it and routes it. It opens no payer episode. Records and third-party payers are added on purpose, over referral and payer episodes.
No clinical decision is made here and no payment is debited. A submission to a payer is not a promised reimbursement: the organization decides, and the authorized person at the clinic confirms eligibility.
What this changes for your business
Dental specialties
Orthodontics, implantology, surgery: the initial consultation depends on the referral received and on imaging already done. A stage of the approved plan is booked once its administrative prerequisites are on file, and the plan version used is the one that was approved.
Medical clinics and diagnostics
The referral carries the priority written by the referring physician, and that is the priority that counts. Missing documents blocking a booking are named on the first call, rather than discovered the day before the exam.
What it receives
- The payer, the file number and the authorization, as declared
- Documents sent by the patient, the referring party or an authorized employer
- Approved session counts and authorized dates recorded on file
- Your instructions on what may be asked for, and of whom
What it produces
- A complete administrative episode, with its list of documents received and missing
- An alert before an authorization expires or the last approved session is used
- A submission prepared, checked and followed through to its status
- A history of submissions, refusals and resubmissions on the same episode
The authorized person confirms eligibility and the clinician signs the reports. No data leaves for a payer that was not authorized for this file, and a rejected invoice opens a controlled resubmission rather than an automatic resend.
What is metered, and what comes from elsewhere
The add-on carries its own allowance, separate from the calls in the base.
- Twenty-five administrative episodes handled per month, reset at each period
- Attachment pages read and filed against those episodes
- Tracking an open episode continues from one period to the next
- Calls stay metered on the base, separately from this add-on
Any third-party fees — a certified transmission tool, document delivery by an outside provider — are separate and billed by that provider.
With clinic software
The status shown is technical qualification. With no automated read, the episode is held in Zenvox and the clinic enters what its own software shows.
- JaneTo qualifyAccess runs through an approved partnership. Reading authorizations, remaining sessions and invoices still has to be qualified before any automatic alert.Jane
- ClinikoTo qualifyAn interface key carries its user's permissions: that permission boundary has to be tested before reading a payer file.Cliniko
- Dentitek, Progident, ABELDentTo qualifyAvailable sources illustrate what dental practices need; they establish no interface access at those vendors.DentitekProgidentABELDent
Questions about this add-on
Does Zenvox transmit directly to a public compensation board?
No. The submission to the payer is prepared, checked and followed to its real status, refusals included, but it goes out on the official channel the clinic already uses: Zenvox does not invent a transmission route into a public body.
Does a prepared submission mean the patient will be reimbursed?
No. A submission to a payer is not a promised reimbursement: the organization decides, the authorized person at the clinic confirms eligibility, and the clinician signs the reports.
How do I see that an authorization expires before the session?
The add-on tracks the end date and the number of approved sessions, and warns ahead of the session concerned. The clinic clears it up with the patient instead of finding out at billing time, a month later.
Do the documents people send end up in a shared folder?
No. Documents received are read and attached to the right episode, with a checklist separating what arrived from what is outstanding: prescription, the payer's own form, the referral received, imaging already done.
Does a rejected invoice get resent on its own?
No. A rejected invoice opens a controlled resubmission rather than an automatic resend, and no data leaves for a payer that was not authorized for this file. The history of submissions, refusals and resubmissions stays on the same episode.
Where to next
Go back to your practice, or look at the add-on that coordinates multi-stage pathways.
Files and third-party payers