Use case · clinics & medical practices

The remittance reconciliation where every denial ties back to the file

The agent reads the files your practice already receives — 835 remittances, EOBs, billing reports — and writes a reconciliation where every payment and denial points to its source line. Protected data only enters the answer for someone allowed to see it.

The question this use case answers

How does a US clinic reconcile payer remittances and compute collections per provider with every figure traceable to its source claim?

The files you already have

  • 835 / ERA remittance advices
  • EOBs and 837 claim files
  • Billing and AR reports (.xlsx / CSV)
  • Bank deposit files (CSV / OFX)
sample

How much did the payer deny in May?

$12,480

era_may_payerX.835 · batch 084 · you have access

Illustrative figure (sample) with fictional data — not a customer result or benchmark.

How the agent handles it, step by step

  1. 1

    Upload the month's remittances

    Drop in the files each payer sends. No integration — the agent identifies the 835s and billing reports by format.

  2. 2

    The agent reconciles claim by claim

    Every payment and denial carries where it came from: file, batch and line. The expected-versus-paid math is deterministic, not a model's guess.

  3. 3

    A denial with no remittance becomes a gap

    If a payer's 835 hasn't landed, the agent flags the gap instead of closing the reconciliation over an invisible hole.

  4. 4

    Schedule the monthly reconciliation

    Save the recipe and the agent re-runs it each payment cycle, with a versioned audit trail.

Permission at synthesis time

In a practice, patient data is protected data. Redijo checks the permission of each fragment at synthesis time: billing staff see the payment figure without restricted clinical data leaking — not even inside an aggregated total. Permission holds the moment the answer is written, not just at retrieval.

A practice loses money two ways: the denial nobody appealed and the payment nobody checked. Both have the same root — nobody can trace the figure back to the claim. Generic AI tools make it worse: they return a plausible revenue-cycle summary without saying where each figure came from.

Redijo starts with the proof. The agent reads the 835 remittances, EOBs and billing reports your practice already receives, and writes a reconciliation where every payment and denial points to its source line.

Auditable by construction, not on trust

The proof is born with the answer. Before writing a figure, the agent locates it in a file you uploaded and records its origin — file, batch, line. The expected-versus-paid comparison is deterministic; the AI writes the prose, never the number. That is why the reconciliation is auditable, not just convincing.

Protected data only enters the answer for someone allowed to see it

The second win is privacy. Almost every tool checks access only at retrieval — then lets the AI blend everything. Redijo checks the permission of each fragment at synthesis time. Billing staff close the payment without restricted clinical data appearing, not even hidden inside a total.

Who it’s for

For the practice manager who needs proof to appeal denials, the partner computing collections per provider, and whoever answers for data-protection compliance. Your data is hosted in the cloud, with international-transfer safeguards.

Questions this page answers

Your practice's data is hosted in the cloud, with international-transfer safeguards — a residency posture you can put in writing, never a marketing line.

Reconcile remittances with figures you can audit

Get started and close an auditable reconciliation from the files your practice already receives.

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