Automation Runbooks

Production-ready workflows for insurance, marketplaces, and POS settlements

Every playbook documents the data contracts, integration cadence, and escalation paths required to keep multi-channel revenue flowing. Insurance claim filing is fully templated so Bupa and AXA submissions leave the clinic without spreadsheets or portal re-keying.

Insurance claim filing automation

Generate, submit, and reconcile insurer claims without leaving the Billing Agent. Bupa and AXA pathways are orchestrated end-to-end.

OwnerRevenue Operations LeadCadence: Hourly runs with nightly catch-up

First-time acceptance94%(target >= 92%)

Average adjudication36h(target < 48h)

Manual interventions3/week(target <= 4/week)

Triggers

Encounter signed-off with billable insurer package
Supporting documentation updated or received
Remittance file posted by insurer to monitored channel

Prerequisites

Bupa SFTP credentials stored in Motics Secrets Manager
AXA Health robotic portal session configured
CCSD to CPT procedure mapping validated for each clinic

Automation Channels

Bupa UKSFTP
EDI batches sent with HL7 attachments once validation passes schema checks.
Endpoint: sftp://edi.bupa.co.uk/inbox
Cadence: Hourly 06:00–22:00 GMT
```
sftp provider_uat@edi.bupa.co.uk <<'EOF'
cd inbox
put ./exports/bupa/CLM-{{claimId}}.xml
bye
EOF
```

AXA HealthPortal

Robotic flow uploads .edi payloads and supporting PDFs, capturing claim IDs for tracking.

Endpoint: https://provider.axahealth.co.uk/api/claims

Cadence: Nightly queue with on-demand retries

const response = await fetch("https://provider.axahealth.co.uk/api/claims", {
  method: "POST",
  headers: {
    Authorization: "Bearer " + process.env.AXA_SESSION_TOKEN,
  },
  body: buildAxaFormData(claimPack),
});
await persistAxaClaimReference(claimPack.claimNumber, await response.text());

Execution Stages

1
Pre-flight validation
Ensure documentation aligns with insurer policy requirements before queuing a claim.
- Eligibility & authorisation check
  Confirm coverage dates and pre-authorisation numbers with insurer APIs; route exceptions to front desk teams.
  Outputs: eligibility.json
- Clinical coding audit
  Map diagnosis and procedure codes to insurer dictionaries via the coding rules engine.
  Outputs: coding-audit.csv
2
Claim pack assembly
Build compliant EDI payloads with attachments and signatures.
- Generate insurer-specific payload
  Merge SOAP notes, invoices, and consent forms into the insurer XML template.
  Outputs: claim.xml, attachments.zip
- Hash and archive
  Create SHA256 digests for every attachment prior to submission and archive into cold storage.
  Outputs: hash-report.json
3
Submission & tracking
Dispatch the claim and follow acknowledgements through to adjudication.
- Dispatch payload
  Route via SFTP or robotic portal automation based on insurer readiness with automatic retries on transient failures.
  Outputs: dispatch-log.ndjson
- Monitor adjudication
  Poll remittance drops and update claim status; escalate rejections with templated next actions.
  Outputs: remittance.json
4
Cash application
Apply receipts to patient balances and general ledger.
- Match remittances
  Match insurer payment amounts to outstanding balances with configurable tolerance rules.
  Outputs: cash-application.csv
- Post journals
  Push approved journals to the accounting platform and notify finance leads.

Alerting & Response

EDI rejection
Condition: Insurer returns rejection code or error acknowledgement
Response: Open a revenue operations task with recommended fix and notify the clinician of missing artefacts.
SLA breach
Condition: No adjudication received within 48 hours of submission
Response: Escalate to insurer account manager and surface claim in the high-priority dashboard lane.

Marketplace settlement reconciliation

Normalise ClassPass and Treatwell deposits, reconcile fees, and generate GL-ready journals automatically.

OwnerFinance Systems AnalystCadence: Daily 05:00 UTC sweep

Variance per batch£42(target < £100)

Unmatched items6(target < 10)

Manual reviews2/day(target <= 2/day)

Triggers

Marketplace payout webhook received
New booking adjustments detected
Finance team requests historical replay

Prerequisites

ClassPass and Treatwell API keys stored in secure vault
Chart of accounts mapping completed
Variance thresholds configured per clinic

Automation Channels

ClassPassAPI
Fetch settlement payloads and attach booking metadata before ingestion into the warehouse.
Endpoint: https://partner-api.classpass.com/v1/payouts
Cadence: Webhook trigger with hourly catch-up
```
const payouts = await classpassClient.payouts.list({ status: "available" });
await queuePayoutsForReconciliation(payouts);
```
TreatwellAPI
Download settlement CSVs and convert to unified Motics ledger schema.
Endpoint: https://api.treatwell.com/v3/finance/payouts
Cadence: Daily at 05:00 UTC

Execution Stages

1
Ingestion
Collect settlement data from each marketplace and load into the warehouse.
- Download settlement files
  Invoke provider APIs or CSV exports and store raw files in object storage buckets.
  Outputs: classpass-settlement.json, treatwell-settlement.csv
- Normalise schema
  Transform marketplace payloads into the Motics payout schema and enrich with clinic metadata.
  Outputs: payouts-normalised.parquet
2
Reconciliation
Match payouts to the clinic ledger and compute variances.
- Ledger matching
  Join payouts to sales ledger entries using booking IDs and patient references.
  Outputs: matched-ledger.csv
- Variance analysis
  Flag differences beyond configured tolerance and auto-assign to the responsible team.
  Outputs: variance-report.json
3
Journaling
Publish journals and update finance dashboards.
- Create journal entries
  Aggregate reconciled payouts into balanced journal entries for the accounting platform.
  Outputs: journals.csv
- Notify finance
  Send Slack notifications with summary metrics and outstanding variances.

Alerting & Response

Variance threshold breached
Condition: Variance exceeds configured tolerance for a payout batch
Response: Create finance review task and hold journal posting until resolved.
Missing payout
Condition: Expected marketplace payout not received by settlement date
Response: Trigger follow-up with marketplace support and flag in cash flow dashboard.

In-clinic POS close-out

Synchronise Stripe Terminal and Square takings, confirm deposits, and resolve card disputes proactively.

OwnerClinic Operations ManagerCadence: Every 2 hours

Same-day settlement98%(target >= 97%)

Dispute backlog4(target < 5)

Manual checks1 shift(target <= 1 shift)

Triggers

New POS payment recorded
Provider settlement event received
Dispute opened on card network

Prerequisites

Stripe Terminal and Square OAuth connections active
Dispute routing rules configured
Clinic cash drawer schedule defined

Automation Channels

StripeAPI
Stream card-present takings into the warehouse with fee breakdowns for settlement checks.
Endpoint: https://api.stripe.com/v1/payment_intents
Cadence: Every 2 hours
SquareAPI
Fetch settlement batches and confirm deposits to the clinic bank account.
Endpoint: https://connect.squareup.com/v2/settlements
Cadence: Hourly

Execution Stages

1
Takings aggregation
Capture all POS activity across providers.
- Stream payments
  Use provider APIs to capture transactions and store them with terminal identifiers.
  Outputs: pos-payments.json
- Group by shift
  Aggregate takings per clinic shift to prepare for reconciliation with bank deposits.
2
Settlement verification
Match takings to bank deposits and highlight discrepancies.
- Compare expected vs received
  Calculate expected settlement after fees and compare to actual deposits.
  Outputs: settlement-diff.csv
- Dispute monitoring
  Detect open disputes and route to the clinic operations team for evidence upload.
3
Close-out reporting
Publish shift reports and update dashboards.
- Generate close-out report
  Create PDF summary for each shift including takings, deposits, and outstanding exceptions.
  Outputs: shift-report.pdf
- Notify stakeholders
  Send notifications to clinic management with dispute status and settlement ETA.

Alerting & Response

Settlement delay
Condition: Deposit not received within expected settlement window
Response: Escalate to finance and open provider support case with settlement identifiers.
Dispute opened
Condition: Card network dispute created
Response: Auto-assign to operations with evidence checklist and due date aligned to response SLA.