EOBs

For  EOBs

Our EOB Processing solution is based on the DocXP™ platform which is equipped with specialized modules and enhancements designed in collaboration with healthcare service professionals.

 The core DocXP™ system and its modules can be found here.

DocXP™ EOB processing is designed to:

• Remove paper from circulation
• Dramatically reduce data capture costs by increasing accuracy and speed of data capture
• Reduce costs of A/R
• Provide an expandable system equally efficient in centralized and distributed processing
• Improve business rapport with insurers
• Revitalize accounts receivable service by providing immediate electronic access to payment data and images
• Reduce or eliminate costs of handling denials
• Smoothly interface with a downstream accounting systems
• Improve financial oversight

Specialized functionality in DocXP™ for processing EOBs  

• Complex table processing

Explanations of Benefits may contain very complex and idiosyncratic tables whose structure changes significantly from insurer to insurer.  Peladon has developed a powerful and innovative Intelligent Data Capture (IDC) module capable of untangling the complexities of these tables.

Our approach does not involve any special computer programming effort nor a specialized computer description language frequently designed just for the purpose of describing complex table records.  Instead we use a simple graphical interface accessible to an average data entry professional.

This new approach can painlessly handle the most complex EOBs and changes in the format of documents should a healthcare provider decide to modify the way of generating their EOBs.

• Remark / Denial code handling

DocXP™ creates and auto populates specialized data structures for remark and denial codes. It can frequently automatically determine the actions associated with these codes i.e. how and where to apply them. The operator is also given all the necessary tools to confirm, override and cancel them.  Our solution can deal with the changing interpretation of these codes depending on their place in the flow of information.

• Character Inspection

Our EOB solution also delivers the ultimate accuracy of data by subjecting, if desired, all characters that can not be validated externally to a fast Character Inspection process. The net result is comfort and confidence of the user and particularly the outsource processor in the quality of the data supplied to the health care provider.

• Output format:  EDI 835

Our solution can output data in any desired format such as XML, comma delimited file, ODBC, etc. Via the COM interface it is possible to comply with even more esoteric output formats, with or without images. Further, we can create various combinations of image and text data to fit the specific needs of customers.

Through our partners we are also capable of delivering the data in EDI 835 format.

Features:

• Powerful processing solution designed in collaboration with health service providers
• Innovative capture of complex table data
• Open client-server architecture
• Simple and intuitive user interface
• Automatic processing of Fax-received EOBs
• Electronic input file importing: PDF, Excel, XML.
• Powerful image enhancement
• Customizable to accommodate specific requirements
• Configurable views, e.g. thumbnails, multiple page viewing etc.
• Clean and simple scanning interface that allows the operators to keep up with very high speed (3500 pages an hour) and low speed scanners in the same environment
• Fully scalable remote and on-site paper EOB scanning
• Web service and associated clients for moving images from one site to another with or without a scheduler
• Fully automated insurer identification
• Holistic approach to the identification and classification of pages of unstructured documents delivers robustness against variability of layouts
• No human computer programming or script language utilization
• Dynamic “on the fly” addition of new payers and documents
• Ready to handle unseen images on first presentation
• Requires no human intervention and no human definition of features to be used for identification
• Handles any document layout: from structured to unstructured
• Simple and intuitive graphical user interface suitable for unskilled data entry operators
• Powerful field-specific post-processing logic compensates for typical OCR errors
• Captures all relevant data: provider number, provider and patient name, date, line item data, amounts, etc.
• The most complex tables are processed with ease
• Format compliance verification
• Works with complete or partial integration with IDNs, HMOs, TPAs and MSOs
• COM interface can be used to embed custom validation and menu options and create custom dialogs of any complexity within the index screens
• Superior exception handling
• Special mode for random or controlled quality checking
• Special review screens for complex EOBs
• Electronic Document Filing (EDF) for processing Word, Excel, PDF and other electronic files within Doc XP
• Retrieval through browser only or desktop client retrieval
• Disaster Recovery system
• Ability to print or e-mail from the explorer interface or import directly to the explorer interface
• Ability to attach image to A/R records

We are happy to answer any questions about the EOB processing solution if you contact us.