MedSynthea + Healthie for Pulmonology Billing
Connect MedSynthea to Healthie via REST API to automate Pulmonology revenue cycle workflows end-to-end — from eligibility verification through CPT 94002-94799 coding and ERA payment posting, with 0% PHI in system logs.
Deploy Pulmonology Automation with Healthie in 4 Steps
REST API integration — no EHR vendor changes required.
Authenticate Healthie
Authorize MedSynthea via REST API. No vendor changes required — standard OAuth2/SMART credentials used.
Map Pulmonology Workflows
Configure CPT 94002-94799 (Respiratory) fee schedules, payer contracts, and sleep study prior auth prevention rules.
Activate AI Agents
9 agents begin processing Pulmonology encounters from Healthie: eligibility, coding, scrubbing, and claim submission.
ERA Write-Back
Approved payment data posts back to Healthie via REST API write-back, closing the billing loop automatically.
Pulmonology Revenue Cycle Challenges MedSynthea Solves in Healthie
Pulmonology billing is governed by CPT 94002-94799 (Respiratory) coding complexity and strict payer LCD policies.
Sleep study prior auth
Healthie practices in Pulmonology face repeated denials for sleep study prior auth. MedSynthea reads clinical notes from Healthie via REST API and flags documentation gaps before claim submission.
CPT 94002-94799 (Respiratory)
MedSynthea's CODE agent validates all CPT 94002-94799 (Respiratory) codes pulled from Healthie clinical documentation against NCCI edit tables and payer-specific modifier rules.
Sleep study prior authorizations are denied in 29% of initial requests due to incomplete Epworth Sleepiness Scale documentation and insufficient daytime symptom capture in physician notes (AASM 2024).
9 AI Agents Working Inside Healthie for Pulmonology
Each agent reads from and writes back to Healthie via REST API for a closed-loop Pulmonology 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 Healthie: reads CPT 94002-94799 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 Healthie: reads CPT 94002-94799 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 Healthie: reads CPT 94002-94799 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 Healthie: reads CPT 94002-94799 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 Healthie: reads CPT 94002-94799 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 Healthie: reads CPT 94002-94799 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 Healthie: reads CPT 94002-94799 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 Healthie: reads CPT 94002-94799 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 Healthie: reads CPT 94002-94799 data via REST API
Other Specialties Supported in Healthie
MedSynthea automates all major specialties within Healthie via REST API.
Pulmonology Billing in Other EHR Systems
Healthie + Pulmonology Integration — Frequently Asked Questions
How does MedSynthea integrate with Healthie for Pulmonology billing?
MedSynthea connects to Healthie via REST API, reading clinical encounter data and writing approved CPT 94002-94799 (Respiratory) codes and documentation back into the EHR automatically — without any custom software engineering.
Does MedSynthea support Healthie for Pulmonology prior authorization?
Yes. MedSynthea's PA agent reads Pulmonology encounter data from Healthie via REST API, assembles required clinical documentation, and submits prior authorization requests automatically for Pulmonology procedures.
What Pulmonology CPT codes does MedSynthea validate in Healthie?
MedSynthea's CODE agent validates CPT 94002-94799 (Respiratory) against payer LCD policies and NCCI edit tables, then writes approved codes directly into Healthie with full evidence traceability — every code linked to source clinical notes.
How long does Healthie + MedSynthea setup take for a Pulmonology practice?
Most Pulmonology practices complete Healthie integration in under 2 weeks. MedSynthea authenticates via REST API — no EHR vendor code changes required. Configuration covers fee schedules, payer contracts, and Pulmonology-specific denial rules.
Connect Healthie to MedSynthea for Pulmonology Billing
Zero custom engineering. REST API authentication. Live Pulmonology automation in under 2 weeks.
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