DrChrono Find Charge

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Authentication

• access_token

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drchrono_find_charge

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Inputs

• patient_name: Patient name from the EOB line item, such as Jane Smith, Smith, Jane, or SMITH JANE.
• date_of_service: Date of service. Prefer YYYY-MM-DD; MM/DD/YYYY is also accepted.
• procedure_code: Procedure/CPT code to match. Modifiers are allowed; matching uses the base CPT, so 99213 25 matches 99213.

• insurance_name: Insurance name from the EOB. Used only for deterministic matching against DrChrono appointment insurance.
• check_number: Check or trace number from the EOB. Used to detect if the payment was already posted.
• max_patients: Defaults to 10. Maximum patient candidates to inspect.
• max_line_items: Defaults to 50. Maximum line items to inspect per patient.
• max_transactions: Defaults to 50. Maximum transactions to inspect for the matched line item.

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Matching Behavior

• generates common patient-name candidates, including EOB-style last-first names,
• searches DrChrono patients by first and last name,
• fetches line items for the patient and service date,
• matches by exact service date and base CPT code,
• enriches the match with doctor, appointment insurance, and transaction data,
• normalizes check_number and transaction trace_number for duplicate-check detection,
• returns deterministic insurance candidates and match confidence without calling an LLM.

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Output

• found: true
• patient: matched DrChrono patient summary
• match: EHR charge, balance, provider, carrier, duplicate-check, and status fields
• payment_input: forward-compatible data for a future payment-posting tool

{
  "found": true,
  "patient": {
    "id": "123",
    "first_name": "Jane",
    "last_name": "Smith"
  },
  "match": {
    "ehr_charge_id": "456",
    "ehr_patient_id": "123",
    "ehr_visit_id": "789",
    "date_of_service": "2026-05-01",
    "ehr_cpt_code": "99213",
    "ehr_charge_amount": "100.00",
    "ehr_insurance_balance": "70.00",
    "ehr_patient_balance": "30.00",
    "ehr_carrier": "Acme Health",
    "already_posted": false,
    "insurance_match_confidence": "exact"
  },
  "payment_input": {
    "patient_id": "123",
    "line_item_id": "456",
    "appointment_id": "789",
    "carrier_id": "PAYER1",
    "carrier_name": "Acme Health",
    "ehr_insurance_balance": "70.00",
    "ehr_patient_balance": "30.00",
    "already_posted": false
  }
}

• drchrono_not_connected: DrChrono is not connected. The agent should ask the user to either connect DrChrono and try again, or stop the task.
• patient_not_found: no DrChrono patient matched the supplied name candidates.
• charge_not_found: patients were found, but no line item matched the date of service and procedure code.
• ambiguous_insurance: a charge was found, but the supplied insurance name could not be deterministically matched to multiple DrChrono insurance candidates.

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Agent Instruction Guidance

1. For each EOB line item, call DrChrono: Find charge with:
   - patient_name from the EOB line item
   - date_of_service from the EOB line item
   - procedure_code from the EOB line item
   - insurance_name if available
   - check_number if available

2. If reason is drchrono_not_connected, use Ask User with only these options:
   - Connect DrChrono and try again
   - Stop task

3. If already_posted is true, do not route the line item to payment posting without human review.

4. If the result reason is patient_not_found, charge_not_found, or ambiguous_insurance, ask for review rather than guessing.