Kit contents
HIPAA Insurance Verification Kit
- 01Insurance card capture (front + back) with mobile camera supportform
- 02Subscriber details (name, DOB, relationship to patient, employer)form
- 03Secondary insurance fields with conditional branchingform
- 04Authorization to verify benefits and submit claims (e-signed)form
- 05Pre-treatment cost-estimate request (optional, for cash-pay-aware practices)form
- 06Patient confirmation - upload received, no PHI in bodyemail
- 07Billing-team notification - 'new verification request, click to view' with no member ID or card contentemail
- 08Front-desk fallback if card image unreadable or partialemail
- 09Patient-facing benefits summary email after verification (PHI-stripped, links to authenticated portal)email
- 10Internal alert if verification is stalled past SLAemail
- 11Routing of card images to billing-team Jotform queue only - never via email attachmentworkflow
- 12Auto-flagging of unreadable or partial card uploads for front-desk follow-upworkflow
- 13Structured export to billing tool or clearinghouse (CSV, JSON, or webhook)workflow
- 14Audit-trail note on every verification attempt and outcomeworkflow
- 15Conditional branching for self-pay, primary-only, and primary+secondary insuranceworkflow
- 16Jotform HIPAA plan with signed BAA - requiredintegration
- 17Billing tool or clearinghouse handoff (Availity, Office Ally, or comparable - via CSV or webhook)integration
- 18PHI-safe storage for card images (Jotform retention or BAA Drive folder)integration
- 19EHR handoff to attach verification record to the patient chartintegration
- 20Optional SMS confirmation via BAA-covered SMS providerintegration
- 21Mobile-first card-capture flow with auto-rotation and crop hintsextra
- 22Bilingual capture (English + Spanish)extra
- 23Front-desk dashboard showing today's verifications and outstanding itemsextra
- 24Decision-log template documenting BAA chain for billing handoffextra
