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AI agent for medical billers

Payment Posting Variance Agent

Accurate payment posting with underpayments caught

Payment Posting Variance Agent: what goes in, what the agent does and what you get

What it does

Payers often pay less than the contract allows, and underpayments buried in remittance files are rarely caught by hand. When electronic remittances arrive, this agent posts payments and checks each line against the expected amount from the payer contract. It flags underpayments over 10 dollars, wrong adjustments and patient responsibility errors, but applies allowed contract reductions first so they are not flagged. It then totals each remittance against the bank deposit. If the deposit and remittance differ, it looks for missing files or bundled payments and rematches; a deposit still unmatched after five days is escalated. It drafts underpayment appeals with the contract terms attached. The biller approves every posting with a variance and every appeal; the agent never submits appeals itself. Edge case: a payer pays a multi-procedure claim at a reduced rate that the contract allows, so the agent applies that rule before flagging.

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, continueApprovedNo 1 STARTS WHEN Remittance received 2 USES A TOOL Post payments 3 DOES Compare to expected contract amounts 4 USES A TOOL Match remittance totals to bank deposits 5 CHECKS THE RESULT Do deposits match remittances? If not: look for missing files or bundled payments andrematch. Back to step 4. 6 YOU APPROVE Biller approves variances and appeals 7 RESULT Posting and variance report
Read the steps as a list
  1. Remittance received
  2. Post payments
  3. Compare to expected contract amounts
  4. Match remittance totals to bank deposits
  5. Do deposits match remittances?If not: look for missing files or bundled payments and rematch. Back to step 4.
  6. Biller approves variances and appealsThe agent waits here for your OK.
  7. Posting and variance report

How it decides

It compares paid amounts to contract rates after allowed reductions.

  • Paid under contract by over $10: flag
  • Allowed reduction rule applies: no flag
  • Deposit unmatched for 5 days: escalate

Make it yours

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

  • Variance threshold
  • Payers in scope
  • Deposit matching window
  • Report format

What keeps you in control

It always asks you first

  • Posting variances
  • Appeals

Hard limits

  • Never moves money
  • Never changes contract rates

It stops when

  • Done: posted and reconciled
  • Stop: contract rates missing

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 payer remittance of $48,200 arrived on June 3. The first deposit match failed because the bank showed $46,700. The agent found a second remittance file of $1,500 bundled into the next day's deposit, then matched both. It also found 14 claims paid at last year's contract rates, $1,960 short in total. It drafted one appeal for all 14, which the biller approved.

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