Capability C5
Multi-payer billing and accounting integration
A case can be billed to more than one payer. Each payer has its own rules, codes, and remittance format. The billing service keeps them apart and posts each invoice to the ledger.
Partly builtReference parts exist; the solution layer is designedReconciliation and payment governance have reference implementations. The payer rules and the accounting connectors are designed for this solution.
What happens
- The billable items are split by payer according to the case agreement.
- Invoices are created and posted to Xero or MYOB.
- Remittance and payment status come back and are matched to the invoice.
How the AI platform addresses it
- Payer rules are held as configuration, so a rule change does not require a code change.
- Claims to payers use X12 837, and remittance comes back as X12 835. Each transaction is acknowledged and tracked.
- Payments are matched by reference. An unmatched payment is routed to an accountant with the candidates shown.
AI role
Suggested matches for unmatched payments, and anomaly flags on invoices and payments. Each suggestion shows its basis.
Approval
The billing coordinator approves invoices. The accountant approves matches.
Systems involved
- Billing service
- Xero
- MYOB
- Payer exchanges (X12)
- Audit ledger
Reference components
- ACH payment reconciliation
- Claim payment governance