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AI agent for medical billers

Authorized Visit Balance Agent

No patient runs past an authorization, because extensions are requested early with the right documentation.

MonitoringAdministrationHealthcare
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Authorized Visit Balance Agent: what goes in, what the agent does and what you get

What it does

Patients run out of authorized visits in the middle of treatment, and the clinic finds out when a claim is denied. The agent reads each active plan, the number of visits authorized and used, and the next scheduled visits. When a patient is within two visits of the limit, it checks the chart for medical necessity and drafts an extension request with progress notes and goals. If the payer asks for more information, it adds the missing note and resubmits for approval. It tracks the decision and updates the schedule. Edge case: an authorization that expires by date before the visit count runs out.

How it works

Follow the arrows from top to bottom. The orange dashed arrow is the loop: when a check fails, the agent goes back and tries again.

Start and resultWhat it doesA check on its own workWaits for your OKGoes back and retries
Yes, continueApprovedYes, continueNoNo 1 STARTS WHEN Daily balance check 2 USES A TOOL Read authorizations and completed visits 3 DOES Compute visits left and days left for each plan 4 CHECKS THE RESULT Is any patient within 2 visits or 14 days of alimit? If not: Mark the plan as safe and check again after thenext visit. Back to step 2. 5 USES A TOOL Read the chart for progress and medical necessity 6 DOES Draft the extension request with goals and notes 7 YOU APPROVE Clinician approves the request 8 USES A TOOL Submit and track the payer response 9 CHECKS THE RESULT Did the payer approve without asking for more? If not: Add the missing note or form and resubmit afterapproval. Back to step 8. 10 DOES Update the schedule and visit balance 11 RESULT Authorization status list
Read the steps as a list
  1. Daily balance check
  2. Read authorizations and completed visits
  3. Compute visits left and days left for each plan
  4. Is any patient within 2 visits or 14 days of a limit?If not: Mark the plan as safe and check again after the next visit. Back to step 2.
  5. Read the chart for progress and medical necessity
  6. Draft the extension request with goals and notes
  7. Clinician approves the requestThe agent waits here for your OK.
  8. Submit and track the payer response
  9. Did the payer approve without asking for more?If not: Add the missing note or form and resubmit after approval. Back to step 8.
  10. Update the schedule and visit balance
  11. Authorization status list

How it decides

It counts visits and expiry date against the authorization and treats two visits or 14 days before either limit as the time to request more.

  • Request more at 2 visits left or 14 days to expiry
  • Use only chart facts, never invent progress
  • Pause scheduling past the limit until approved
  • Follow up with the payer after 5 days

Make it yours

Every agent is a starting point. You choose these settings for your own situation.

  • Visit and day triggers (default 2 visits, 14 days)
  • Payers and their forms
  • Follow-up days (default 5)
  • Who is notified

What keeps you in control

It always asks you first

  • Clinician approves each extension request
  • Clinician approves any change to the treatment plan

Hard limits

  • Never submit documentation without the clinician's approval
  • Do not exaggerate progress

It stops when

  • Done: extension approved or the patient discharged
  • Stop: the payer denies and the clinician decides on appeal or self-pay

Set it up

We guide you through the set-up, step by step

Members get the full set-up guide for this agent. No technical skills needed: you copy, paste and upload.

10 minto set it up in your AI
5 AIsChatGPT, Claude, Copilot, Gemini, Grok
  • One set of instructions to paste into your AI, with the clicks for ChatGPT, Claude, Microsoft 365 Copilot, Gemini and Grok
  • The agent then walks you through connecting your own data, one source at a time
  • A downloadable copy with the flow chart, the rules and the full guide
Get access to this agent

An example run

What happensA patient has 12 of 12 authorized visits scheduled to finish soon, with 2 left. The agent drafts an extension for 6 more with the latest range of motion scores. The clinician approves. The payer asks for a functional goal, so the agent adds it, the clinician approves a resubmission, and the payer approves 6 visits.

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