Explanation of Benefits

Hospitals and group medical practices – commonly called Providers - face a significant capture challenge every day: processing the remittance paperwork that accompanies payment from health insurance carriers, a document known as an Explanation of Benefits (EOB).

The challenge Providers face is the accurate processing of each EOB, to determine full payment has been received and the claim can be closed or if it must be resubmitted. Since EOB data is used to update the remittance processing system and patient medical records, there is often significant data entry involved.

Although electronic-based end-to-end claim processing is increasing and paper-based Explanation of Benefit (EOB) processing is in decline, MEDFileshare believes that the use of paper-based EOB forms will never completely disappear. So to help organizations with the challenge of minimizing the effort associated with processing paper-based EOB forms, MEDFileshare has developed its Healthcare EOB Processing solution. The solution automates the process of identifying and reading data on paper based EOB forms and creates 835 HIPAA compliant files. The benefits to your organization and your healthcare clients include improved staff productivity, more accurate submissions of 835 files and increased accounts receivable predictability.

Traditionally, EOB processing is performed manually and creates a bottleneck in workflow and productivity. The MEDFileshare solution automates the capture, recording and managing of various forms and documents by utilizing Intelligent Document Recognition technology. The solution uses forms recognition to determine the source of the document, intelligent character recognition to read data from the scanned document, and validations and balancing logic to ensure that the total line items balance to the paid amount.

The solution outputs an extract data file and stores document images on an image file server, eliminating the need for traditional paper delivery of EOBs. The MEDFileshare system can work in conjunction with any remittance processing system that is capable of providing data and images in the predefined format. MEDFileshare also provides long term, secure access to EOB imaged documents online  to provide a total solution.