Simplex handles the pain of payer portal automation for you.
Conservative therapy attempted?
X-ray confirms grade III–IV OA?
BMI within surgical threshold?
ICD codes surface questions you haven't seen yet
Diagnosis codes trigger new questions mid form. Not just on drug codes, but payer specific criteria and patient history too. A static automation is brittle and breaks on the next patient.
"resourceType": "ServiceRequest",
"status": "active",
"code": "27447",
"diagnosis": "M17.11",
"authNumber": "PA-2024-88471",
"payer": "Humana",
"approved": true
Portal answers need to become structured data
Each portal labels fields differently. Turning responses into clean output -- FHIR JSON, internal schemas, EHR fields -- requires mapping form questions and updating them every time a portal changes. Simplex does this automatically.
Availity
CoverMyMeds
Cigna
UHC
CarelonEach payer portal is different
Availity, Cigna, Carelon, CoverMyMeds -- every portal has its own UI, session flow, MFA method, and quirks. CAPTCHAs, unexpected popups, and mid-form UI changes mean automation built for one portal breaks on the next.