Case stage 08
Revenue cycle, settlement, and audit
Charges and claims are validated, routed to the correct payer or responsible party, reconciled to remittance and settlement, posted to the financial ledger, and retained with a complete audit history.
Partly builtReference parts exist; the solution layer is designedReconciliation, approval, and payment governance have reference implementations. The Xero, MYOB, Stripe, and Infinicept adapters are designed for this solution.
What happens
- Invoices are created for each payer from the approved rate schedule.
- Invoices are posted to Xero or MYOB, and the receipts are stored in document management with the case.
- Payments from Stripe, Infinicept, or bank transfer are matched to invoices. Differences go to an accountant.
How the AI platform addresses it
- The billing service creates one invoice per payer per case. Each line is checked against the rate schedule by rule before it is posted.
- Payment adapters take payments through each provider, verify its webhooks, and convert each event to one internal payment event.
- Reconciliation matches settlements to invoices by reference, and a payout that needs approval waits for the named approver.
AI role
Suggested invoice lines from the rate schedule, suggested payment matches, and anomaly flags. Each suggestion shows its basis.
Approval
The billing coordinator approves invoices. The accountant approves matches and any refund. A payment above the approval limit needs a second approver.
Systems involved
- Billing service
- Xero
- MYOB
- Stripe
- Infinicept
- Document management
- Audit ledger
Reference components
- ACH payment reconciliation
- Claim payout saga with approvals
- Claim payment governance