Reconciliation Agent: The AI Agent That Posts ERA/EOB Payments and Reconciles Accounts with 99% Accuracy
Eliminates the operational bottleneck in medical billing by processing era/eob files from payers (835 edi), original claim records, contracted fee schedules, patient payment records autonomously while maintaining 100% evidence traceability and zero PHI log exposure.
Performance Metrics
What the Reconciliation Agent Does
Clear, deterministic data inputs and outputs between agents.
Data Received
ERA/EOB files from payers (835 EDI), original claim records, contracted fee schedules, patient payment records
Data Produced
Posted payments, reconciliation reports, underpayment flags, adjustment reason codes, patient balance calculations, payer variance reports
Agent Operational Action
Receives 835 EDI ERA files and EOB documents from payers, matches each payment line to the original claim, posts payments to the appropriate account, flags underpayments against contracted rates, identifies incorrect adjustment codes, calculates patient balance responsibilities, and generates reconciliation reports for financial review
How Reconciliation Agent Connects to the Architecture
Final agent in the revenue cycle — closes the payment posting loop and feeds performance data to LEARN
Receives Data From:
- ERA/EOB files (← payer 835 EDI)
- Original claim data (← BILLING)
- Contracted fee schedule (← configuration)
Sends Output To:
- Posted payments (→ EHR financial module)
- Underpayment flags (→ billing team)
- Performance data (→ LEARN)
- Patient balance calculations (→ patient billing)
PHI Handling and Zero-Trust Compliance
Like all MedSynthea agents, the Reconciliation Agent operates entirely behind our Zero-Trust PHI Scrubber. Protected health information is de-identified and replaced with 15-minute time-to-live (TTL) encrypted tokens before any AI reasoning occurs. System logs contain 0% PHI at any time.
Frequently Asked Questions — Reconciliation Agent
How does the Reconciliation Agent detect underpayments?
The EOB agent compares each payment line against the practice's contracted fee schedule for that payer and procedure code. When payment falls below the contracted rate by more than a configurable threshold, the agent flags the discrepancy, calculates the variance amount, and routes a payer follow-up task to the billing team. Systematic underpayments trigger a contract compliance report for review.
Which ERA and EOB formats does the Reconciliation Agent support?
The EOB agent processes all standard 835 EDI electronic remittance advice files, PDF EOB documents from payer portals, and paper EOB document uploads. For payers that do not provide 835 EDI, the agent processes portal-retrieved EOB PDFs using document extraction and maps the data to the standard reconciliation format.
How does the Reconciliation Agent handle patient balance calculations?
After payer payment is posted, the EOB agent calculates the patient's remaining balance by applying the payer's contractual adjustments, co-pay rules, and deductible accumulation data. The resulting patient balance is written to the EHR financial module and can be routed to your patient billing workflow. No manual calculation of patient responsibility is required.
Does the Reconciliation Agent write payments back to our EHR?
Yes. The EOB agent writes posted payment data, adjustment codes, and patient balance calculations directly to your EHR financial module via SMART on FHIR. This closes the revenue cycle loop without manual data entry — approved payments, contractual adjustments, and patient balances appear in your EHR automatically after ERA/EOB processing.
See the Reconciliation Agent in Action
Watch how our 9 AI agents work together in a 90-second platform demonstration.
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