CloudFiles for revenue cycle management and medical billing
Billing teams on Salesforce still get EOBs, denial letters and payer records requests as paper or PDF mail. CloudFiles files each letter on its record, posts EOB lines for review and builds every appeal packet from the denial case.
From payer mail to an appeal sent on time
In medical billing, every paper or PDF letter from a payer belongs to one patient, one denial case or one payer account. Each denial letter also carries an appeal deadline.
The manual way
- Billers page through each mailroom scan to separate EOBs, denial letters and medical records requests by hand. A denial left in the wrong pile can sit unseen on a desk until the payer's appeal window has already closed.
- Payment posters retype every claim line on a paper EOB into Salesforce, one patient at a time. A single EOB can cover many patients, and one wrong figure can leave a patient balance wrong until someone finally notices it.
- Billers answer a payer's medical records request by emailing visit notes and itemized bills as attachments. With no proof the payer opened them, the same request can come back again, and the claim can stay unpaid meanwhile.
- Billers look up each payer's appeal window in a signed contract kept on a shared drive or in a filing cabinet. When nobody checks the contract in time, a denial case can pass its appeal deadline before anyone starts work on it.
- Appeals specialists build each appeal letter in Microsoft Word, then attach the supporting records to the payer submission one file at a time. A packet sent without one of its records can earn the claim a second denial.
The CloudFiles way
- Every denial in the mailroom scan becomes its own case, with the denial reason and claim number filled in. Each scan is split into single letters first. Each letter is then sorted as an EOB, a denial or a records request and filed.
- Each EOB becomes one remittance record on the billing team's own object, with a child record for every claim line. A payment poster checks every extracted line beside the source EOB, then approves the whole run for every patient in one step.
- The payer receives the requested records by one secure link on the case, and only the payer's own email domain can open it. A flow emails the link to the payer, and each view shows on the case as proof the requested records were opened.
- Every denial case opens with its appeal due date already set from the payer contract's own appeal window. CloudFiles finds that window once in the signed contract, and a flow sets the due date on each new denial case for that payer.
- Each appeal goes out as one PDF, with the letter first and the supporting records behind it in the order chosen. The letter is generated from the denial case with its claim number and denial reason, then merged with those records.
Every payer document matched to the claim it belongs to
Billing teams and billing companies run these jobs in Salesforce Flow, from the first benefits check to the last patient statement.
Benefits verification proof on the request
CloudFiles gives every Health Cloud benefits verification request its own folder. The payer printout behind a phone or portal check stays with the request it proves, where billers can find it.
- A flow on each saved benefits verification request calls the create folder flow action, and the folder appears moments later
- The copy Salesforce files flow action copies each printout attached to the request into that new folder
- The original Salesforce file stays in place until a separate flow step deletes it, so nothing is lost in the copy
Payer fax matching by claim number
CloudFiles finds the claim number on each payer fax saved as a file and matches the fax to its record. Each fax is then marked actionable or not with a reason, so no fax sits in the inbox unexplained.
- Once the fax service saves each fax as a PDF on a Salesforce record, a flow starts the workflow on that file
- A Document AI workflow finds the claim number, matches the record and writes the reason for its decision
- A flow then renames each fax file by its claim number, so billers can spot the right fax in a folder at a glance
Payer uploads filed on the denial case
CloudFiles gives each denial case its own upload request, so a payer or a scanning vendor drops files straight onto the right record. Each upload lands in the case folder without anyone moving it.
- A create file request step inside the case's dataroom names each document the denial case still needs
- The file received event starts a flow as each file arrives, carrying the uploader's email when it is required
- The flow files the upload in the denial case's folder and notes on the case which document has arrived
Every letter for a claim, found in SharePoint
CloudFiles writes the claim number and payer as SharePoint columns on every billing letter. A biller filters the library by claim and sees each EOB, denial and appeal for it without opening Salesforce.
- The set resource property flow action writes each column by its API name, using values from the denial case
- Billers filter the SharePoint library by claim number, then sort the results by payer to find one letter fast
- Each column value comes from the denial case, so a letter's tags always match its Salesforce record
Patient statements in one batch run
CloudFiles generates a patient statement for every person account on a list of open balances in one step. Each statement takes its balance from the record on the day of the run and lands in that patient's folder.
- The generate document (batch) flow action takes one input per open balance and builds one statement per patient
- Every statement uses the latest version of the statement template, so a wording change reaches every patient
- Each statement is saved in the patient's own folder, so the front desk answers a balance question from the record
Client practice folders for billing companies
CloudFiles nests each patient's folder inside the folder of the client practice that patient belongs to. A billing company keeps every client's EOBs and letters apart, and each client team opens only its own folders.
- The create folder flow action places each new patient's folder inside the folder of that client practice's account
- Flows on the team member object grant SharePoint access when a biller joins a client team and revoke it on leave
- A biller who moves to another client team sees the new client's folders in place of the old ones
Key documents we handle for revenue cycle management and medical billing
A billing team works through these six documents every day, and CloudFiles handles other payer paperwork on the Salesforce record the same way.
Explanations of benefits
Payer statements listing each claim line's allowed, paid and patient amounts, posted as one remittance record with a line for every claim.
Denial letters
Payer letters that refuse a claim and state why. Each letter opens its own denial case, which then carries the claim number and the appeal due date.
Appeal packets
The appeal letter and its supporting records joined in one PDF. Each packet is built from the denial case and saved in that case's folder.
Medical records requests
A payer's request for visit notes or itemized bills. The answer is one secure link from the case, with every payer view visible on that case.
Patient statements
The balance a patient owes after insurance, produced for a whole list of open balances at once and saved to each patient's own folder in storage.
Payer contracts
Each payer's signed agreement with its appeal window and filing terms, kept on the payer's account and used to set every appeal due date.
Stay industry compliant
CloudFiles is independently audited for SOC 2 Type II, certified to ISO 27001, and compliant with HIPAA and GDPR. Data residency is supported in the US, EU, UK and AU. Your files stay in your own storage. CloudFiles never re-hosts them, and they are not used to train our AI models.
Frequently asked questions
Yes. CloudFiles creates a folder for each benefits verification request and copies the payer printouts attached to that request into it. Health Cloud marks each benefits verification request as electronic or manual. Each request also carries a status such as verified, pending or rejected.
CloudFiles writes each EOB to one remittance record on an object the billing team builds, plus one child record per claim line. Salesforce documents no provider billing, remittance or claim line objects in the Health Cloud core data model. CloudFiles flow actions run on custom objects as well as standard ones.
CloudFiles finds the appeal window in each signed payer contract and writes it to a field on the payer's account. A flow then dates every denial case from that field as the case opens. Billers work each new denial with its appeal deadline already in view on the denial case.
Yes. CloudFiles logs each view of the secure link, including how long the payer kept the file open. With email verification turned on, each view also carries the email of the payer who opened it. A flow can then disable the link once the claim is paid in full.
Yes. CloudFiles splits a combined mailroom scan on page boundaries and names each new file from its contents. All the parts go into a single new folder, where a flow classifies each letter by type. Each letter then lands in the folder for its type, ready for the biller who works it.
Yes. CloudFiles can give each member plan its own folder inside the patient's folder, so letters from one payer stay apart from another payer's letters. In Health Cloud, a member plan holds the member number, group number and payer for one patient's coverage.
Book your personalized demo
Bring a mailroom scan and a payer contract, and see each letter filed, each denial opened as a case and its appeal date set.