Delivering Healthcare Payment Electronification

The healthcare industry is striving to achieve 100% electronification of payments. Despite the efforts of the government to semi-mandate insurance companies, payers and providers to exclusively utilize EDI 835 electronic remittance advices (ERA) coupled with ACH payments, providers still receive billions of claim payments and remittances via PDF or paper-originated transactions. In fact, according to the latest CAQH Index, electronic transactions actually declined by 1% this year resulting in an increased reliance on EOBs.

Explanation of benefits (EOB) forms are typically generated as a paper or PDF remittance document while checks are the predominant payment type. To process these documents, providers utilize a variety of methods to cope with these non-postable transactions including:

• Internal resources to key transaction data into practice management and hospital information systems
• Outsource data entry to third parties, including off-shore companies
• Contract with revenue cycle management (RCM) firms to convert transactions into EDI 835
• Rely on a clearinghouse as the conversion partner
• Include EOB processing with their bank’s medical/wholesale lockbox services

The ability of a third party RCM, clearinghouse or medical lockbox to deliver an excellent customer experience to the provider rests on their ability to provide an EDI 835 posting file with a high degree of accuracy, short turn-around time and streamlined process at a cost-effective price.

Modernization in healthcare payments occur when these vendors utilize advanced AI and Deep Learning technologies coupled with extensive quality control processes to achieve 100% electronification of remits and payments. The result is an automated cash posting environment for these transactions simplified to the following processes:

• Automated upload of image and EDI 837 data
• Automated download of EDI 835 with access via online content management

OrboAccess with Opti-Lift technologies operationalize AI and deep learning for extraction of posting data from PDF and paper-based remittances as well as correspondence letters while providing full research and system access to transactional data across multiple payment sources.

Companies around the globe recognize that physical data centers with pure data entry staffing is being replaced with cloud-based application deployments. OrboGraph has created a competitive differentiation by implementing an enterprise-grade infrastructure around a unique security implementation which adheres and exceeds strict regulatory compliance requirements of Protected Health Information (PHI), the Health Insurance Portability and Accountability Act (HIPAA) and HITECH. This approach can be deployed in multiple scenarios with RCM companies.

OrboAccess is the platform of the future, delivering the ultimate streamlined experience for electronification and automated posting into any practice management or HIS system. Click below to discuss how we can work with your RCM company, clearinghouse or lockbox in a wide range of configurations.