Given that this remittance advice often contains thousands of detailed transactions, healthcare providers must resort to costly and labor-intensive manual data entry tasks to perform the necessary patient accounting activities. In an effort to automate this process and accelerate billing cycles, healthcare providers have turned to recently available computer-aided recognition technologies designed to extract transaction-based data from paper forms.
While this technology has proven effective at extracting accurate data elements, there remain many processing tasks specific to EOBs that must be addressed for successful implementation to occur. The Optiform eobXL™ for Kofax Capture solution provides the necessary features to address these tasks, as well as the data and image integration requirements, all in an intuitive, “point & click” interface.
Developing an automated solution for processing EOBs using machine print recognition technologies requires a myriad of special features to handle the intricate characteristics and dynamic nature of different EOB form types.
The following is a list of the major features that the Optiform eobXL for Kofax Capture solution provides:
User-Friendly Setup and Administration
A “point & click” user interface that allows end-users to easily configure the classification, extraction, data validation, and reconciliation rules.
HIPAA Compliant Batch Management
A secure scanning and batch management environment enforcing regulations related to patient privacy.
Semi-Structured Forms Processing Engine
A classification and data extraction engine capable of locating machine printed data elements regardless of location within an EOB or the number of occurrences across multiple pages. The engine is also capable of reading data elements that have varying formats such as dates and currency amounts.
Accurate Machine Print Recognition Rates
The OCR (Optical Character Recognition) engine has demonstrated the capability to produce recognition accuracy rates as high as 99.98% requiring character correction of less than 20 characters per 100,000 characters processed.
A “point & click” utility for converting extracted data elements into a standard format.
Hierarchal Data Structure
The underlying data structure is capable of capturing, organizing, and validating data according to the basic structure of an EOB and the data output format required by the patient billing system. This structure includes a claim header record, claim transaction record, claim transaction detail record, and claim footer record.
Automatic Identification and Grouping of Transactions
The solution is capable of correctly organizing the data according to the appropriate transaction-based output format. Claim level transactions on EOBs that break across pages can be kept together as a single transaction with no user intervention.
Automatic Validation of Suspect Characters and Missing Data Elements
The processing solution provides a user-friendly interface for reviewing and correcting characters with low accuracy rates, as well as identifying when data elements are missing from a transaction and need to be reviewed.
Remark Code Processing
The processing solution provides flexible options for capturing both codes and related text descriptions in the various printed formats across different payers.
When claim payments do not balance against the payment total, the processing solution provides an automated mechanism to quickly review payments and correct possible math errors.
The processing solution allows missing pages to be re-integrated with batches in-process when they are obtained at a later date from the payer.
Quality Control Queue
A processing queue is available to handle EOBs with exceptions with the option of routing them to a supervisor or separate process.
The processing solution provides a utility to easily generate a standard HIPAA 835 EDI file capable of being accepted as Electronic Remittance Advice (ERA). The solution also provides mechanisms to populate any required payment data elements that were not contained on the paper EOB.
The EOB processing solution is capable of generating one or more images containing the patient’s claim level transaction detail, as well as the index data required to retrieve the image(s). Furthermore, the solution is capable of redacting (removing) any non-related patient information to produce a HIPAA compliant electronic document.
Optiform offers a broad spectrum of data processing solutions beneficial and able to be customized to fit any business need. From standard human resource departments to the information produced through clinical trials, Optiform has a long history of maximizing the efficiency of all its clients. Although the Optiform to sit and hear your needs, personalized support and recommendations pre and post project ensure your long term sanctification with your paper free results. Contact us today to set up a personalized, one-on-one consultation on software recommendations. Already a valued Optiform client? Our customer support is ready to help.