Key Features

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.

Data Conversion
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.

Payment Reconciliation
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.

Missing Pages
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.

Image Integration
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.