Paper-originated healthcare remittances, known as Explanation of Benefit (EOBs) or Explanation of Payment (EOP) forms, are documents utilized within the healthcare payment process between payers and providers. These forms vary significantly among payers and abide by no single standard in terms of structure, image clarity, or ease of use. Despite an industry-wide effort to replace EOBs with ERAs (Electronic Remittance Advice), payers continue to use EOBs and providers are still heavily tasked with manual interpretations of the data so as to complete/continue the revenue cycle process.
Access EOB Conversion is the name of the OrboAccess module that extracts data from scanned images or PDF documents created from paper-based Explanation of Benefits (EOB) or Explanation of Payments (EOP). The output is a standard EDI 835 file ready for cash posting in Practice Management (PM) or Hospital Information Systems (HIS).
Access EOB Conversion can be utilized in a wide range of environments depending on the needs of the provider:
- Daily conversion and electronification of EOBs and EOPs from insurance companies for providers, clearinghouses, lockbox processors, BPOs, billers or other revenue cycle companies processing transactions on behalf of the healthcare provider for posting automation.
- Daily, weekly or monthly conversion primarily for downstream applications, i.e. denial management, business intelligence as many times these systems do not have access to payment and remittance data generated from EOB/EOP sources.
- Bulk processing: High volume, bulk processing of EOB/EOP paper documents as an on-demand service. Typically, conversions to new systems, updates to EHR platforms and record indexing projects require bulk processing.
- EOB Indexing is available for environments which desire access to EOB images via searchable field criteria. Clipped images are viewable in the HPAC Portal at a transaction level or claim level. Access EOB Indexing is available in two options:
- EOB Lite Indexing: Transactional information only
- Full EOB Indexing: Up to eight fields per claim.
Capabilities and Achievements
New capabilities for OrboAccess EOB Conversion now include:
- Provider Override: Opti-lift technologies extracts data from EOBs/EOPs and matches the description of services to standard ANSI codes. For RCM companies and healthcare organizations looking to control this process, Access EOB Conversion allows users to add rules and logic to select preferred codes.
- Interactive EOB: As data is extracted from a variety of paper and electronic sources, the system creates a Virtual EOB; a consistently formatted template of remittance and payment data. The Virtual EOB is now activated with hyperlinking, applied to a variety of fields, enabling customer service personnel to easily see additional transaction details without manually searching.
- Access Dashboard: A new dashboard capability enables system administrates and aggregators to drill into a wide range of revenue sources and analyze trends. For example, EOB transactions can be analyzed by payer to identify specific claim and payment trends.
- Eliminate the complex multi-step process of data entry, balancing and business rule validation of EOB posting
- Improve efficiencies and reduce costs
- Virtually eliminate posting errors
- Accelerates collections and cash position
- Minimizes delays in secondary billing
- Streamline working denials and improves the cash position of the provider.
- Improve HIPAA compliance position by eliminating manual paper routing and exposure
- Reduce staff management challenges and maximizes FTE utilization
- Free software upgrades
- Performance monitoring and trend analysis by OrboGraph Client Services
- Business Intelligence (BI) and volume tracking
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