MedSynthea + HealthFusion for Radiology Billing
Connect MedSynthea to HealthFusion via REST API to automate Radiology revenue cycle workflows end-to-end — from eligibility verification through CPT 70010-79999 coding and ERA payment posting, with 0% PHI in system logs.
Deploy Radiology Automation with HealthFusion in 4 Steps
REST API integration — no EHR vendor changes required.
Authenticate HealthFusion
Authorize MedSynthea via REST API. No vendor changes required — standard OAuth2/SMART credentials used.
Map Radiology Workflows
Configure CPT 70010-79999 (Imaging) fee schedules, payer contracts, and missing clinical indication prevention rules.
Activate AI Agents
9 agents begin processing Radiology encounters from HealthFusion: eligibility, coding, scrubbing, and claim submission.
ERA Write-Back
Approved payment data posts back to HealthFusion via REST API write-back, closing the billing loop automatically.
Radiology Revenue Cycle Challenges MedSynthea Solves in HealthFusion
Radiology billing is governed by CPT 70010-79999 (Imaging) coding complexity and strict payer LCD policies.
Missing clinical indication
HealthFusion practices in Radiology face repeated denials for missing clinical indication. MedSynthea reads clinical notes from HealthFusion via REST API and flags documentation gaps before claim submission.
CPT 70010-79999 (Imaging)
MedSynthea's CODE agent validates all CPT 70010-79999 (Imaging) codes pulled from HealthFusion clinical documentation against NCCI edit tables and payer-specific modifier rules.
Radiology groups lose 10% of revenue to clinical indication denials — most triggered by missing referring physician documentation rather than imaging errors (ACR 2024).
9 AI Agents Working Inside HealthFusion for Radiology
Each agent reads from and writes back to HealthFusion via REST API for a closed-loop Radiology billing workflow.
Scheduling Agent
Analyzes appointment patterns, flags high-risk no-show appointments, captures scheduling context (procedure type, referral source, insurance class) that affects downstream coding and billing decisions
In HealthFusion: reads CPT 70010-79999 data via REST API
Eligibility Agent
Queries 900+ payer databases in real time, validates active coverage, extracts benefit-level details (co-pay, deductible, out-of-pocket), identifies coverage gaps and prior auth requirements before the encounter begins
In HealthFusion: reads CPT 70010-79999 data via REST API
Documentation Agent
Converts encounter audio into structured clinical text using specialty-aware transcription models. Links every transcribed segment to the specific audio timestamp it came from, creating an immutable evidence chain. Formats output for the NOTE agent to structure into reviewable clinical documentation
In HealthFusion: reads CPT 70010-79999 data via REST API
Coding Agent
Reads structured clinical documentation, applies specialty-specific ICD-10 hierarchies and CPT code families, validates against payer-specific LCD policies and NCCI edit tables, applies correct modifiers, and proposes a complete reviewable code set linked to the clinical evidence that supports each code
In HealthFusion: reads CPT 70010-79999 data via REST API
Scrubber Agent
Scores every claim against 200+ denial variables before submission. Identifies modifier conflicts, missing prior authorizations, LCD coverage gaps, eligibility issues, and payer-specific policy violations. Routes high-risk claims for human review before they reach the payer, preventing denials at the source
In HealthFusion: reads CPT 70010-79999 data via REST API
Prior Auth Agent
Identifies prior authorization requirements from eligibility data and payer rules, assembles supporting clinical documentation, submits PA requests via payer APIs or electronic portals, tracks approval status in real time, and routes approvals back to the clinical workflow and Billing agent
In HealthFusion: reads CPT 70010-79999 data via REST API
Billing Agent
Submits validated claims to payer clearing houses or direct payer APIs, monitors submission acknowledgement in real time, tracks claim status through the payer adjudication process, flags abnormal hold times for follow-up, and passes accepted claims to the FLW agent for ongoing tracking
In HealthFusion: reads CPT 70010-79999 data via REST API
Denial Agent
Receives denial notifications, categorizes each denial by type (clinical necessity, coding, eligibility, authorization), retrieves original claim and clinical documentation, identifies the specific correction needed, assembles an appeal package with targeted documentation, and submits the appeal via payer portal or mail within the payer's filing window
In HealthFusion: reads CPT 70010-79999 data via REST API
Reconciliation Agent
Receives 835 EDI ERA files and EOB documents from payers, matches each payment line to the original claim, posts payments to the appropriate account, flags underpayments against contracted rates, identifies incorrect adjustment codes, calculates patient balance responsibilities, and generates reconciliation reports for financial review
In HealthFusion: reads CPT 70010-79999 data via REST API
Other Specialties Supported in HealthFusion
MedSynthea automates all major specialties within HealthFusion via REST API.
Radiology Billing in Other EHR Systems
HealthFusion + Radiology Integration — Frequently Asked Questions
How does MedSynthea integrate with HealthFusion for Radiology billing?
MedSynthea connects to HealthFusion via REST API, reading clinical encounter data and writing approved CPT 70010-79999 (Imaging) codes and documentation back into the EHR automatically — without any custom software engineering.
Does MedSynthea support HealthFusion for Radiology prior authorization?
Yes. MedSynthea's PA agent reads Radiology encounter data from HealthFusion via REST API, assembles required clinical documentation, and submits prior authorization requests automatically for Radiology procedures.
What Radiology CPT codes does MedSynthea validate in HealthFusion?
MedSynthea's CODE agent validates CPT 70010-79999 (Imaging) against payer LCD policies and NCCI edit tables, then writes approved codes directly into HealthFusion with full evidence traceability — every code linked to source clinical notes.
How long does HealthFusion + MedSynthea setup take for a Radiology practice?
Most Radiology practices complete HealthFusion integration in under 2 weeks. MedSynthea authenticates via REST API — no EHR vendor code changes required. Configuration covers fee schedules, payer contracts, and Radiology-specific denial rules.
Connect HealthFusion to MedSynthea for Radiology Billing
Zero custom engineering. REST API authentication. Live Radiology automation in under 2 weeks.
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