Revenue-Cycle Automation
Automate routine revenue-cycle steps with checks and a person on the exceptions.
What It Does
The agent posts remittance files against the open claims in practice management, clears the lines that match, and opens a denial work item for each one that does not, carrying the payer reason code and the chart detail needed to appeal. Anything it cannot match goes to a person, and every step is logged.Without it: Revenue-cycle work is repetitive and leaks money through small, frequent errors.
- Splits one remittance across the claims and service lines it actually pays
- Leaves a partly paid line open, posting only what the remittance covers
- Stops on a payment short of the contracted rate instead of clearing the line
- Reconciles the clearinghouse acknowledgement against the remittance, and opens a work item where neither lands
Illustrative example
An 835 remittance from a commercial payer posts against the open claims in practice management. The agent clears the matching lines, holds one open where the payment falls under the contracted rate, and opens denial work items grouped by reason code, with the authorization detail attached to each CO-197 line. The biller opens the CO-197 group, sees the same missing authorization behind all of them, and decides which to appeal.
Practice management
Open claims, contracted rates
Clearinghouse
Claim acknowledgements
Remittance advice
835 payment lines
Denial work queue
Open items, reason codes
Revenue-cycle automation
ExecuteStarts when
A remittance file posts, or a claim comes back denied
How far it goes
it acts inside set limits, and every call is logged
Remittance posting
Posted, matched lines cleared
Exception flags
Opened as work items
Audit trail
Logged at every step
More Healthcare Agents
Prior-authorization drafting
Assemble prior-authorization requests against payer rules, ready for a clinician to review and submit.
Clinical-note summarization
Draft encounter summaries from the record, cited and masked, for a clinician to confirm.
Claims adjudication support
Read claims and supporting documents, check them against policy, and prepare a decision for review.
