EXECUTIVE SUMMARY
With millions of healthcare payment transactions to be reconciled with the respective charges on their system, our client, one of the largest cloud-based revenue cycle and EMR software providers, required a scalable solution.
High-volume Explanation of Benefits (EOB) document processing is complex due to multiple payer-specific file formats, varying numbers of line items, and the complexity of payer and provider business rules. The client wanted a solution that eliminates the manual tasks and errors associated with the EoB processing.
The Challenges
While Access Healthcare was already processing these transactions with over 98% accuracy, the challenges were:
Over 3,000 payers and payer-specific EoB formats
Challenges with image quality such as greyscale, blurred, etc. and 100s of non-standard forms /patterns
Over 900 business rules to be used to classify, enrich, apply reconciliation logic, and post the captured data as per payer/provider guidelines
The Solution
Automated sorting and batching of EoBs, application of multiple OCR engines, and comparison of captured data to ensure higher posting accuracy
Pre-configured business rules for thousands of payers using machine learning tools to improve payer format recognition
Applied machine learning to the onboarding of new payers with limited configuration efforts
Rules-based identification of exceptions to allow manual intervention for processing exceptions
The Results
Improved productivity from 650 line items to over 1,000 line items per day
Reduced costs of EoB processing by 50%
Improved quality from 99.5% from automated queues and Improved 98% as against the expected service level of 96%
Over 81 FTEs saved
Experience 2.5x productivity improvement with the industry's most robust payments automation platform, echopay. Access Healthcare currently processes over 100 M manual payment transactions through this engine, with about 85% of transactions not requiring human intervention. echopay utilizes multiple OCR engines for character perfection, machine-learning-powered forms recognition, and artificial intelligence to reconcile payments at a high processing accuracy rate to deliver a near straight-through processing experience.
FAQs on ECHOPAY
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echopay EOB Processing Solution is a platform developed by Access Healthcare that automates the processing of Explanation of Benefits (EOB) and other healthcare-related documents.
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The benefits of using echopay EOB Processing Solution include increased efficiency, reduced errors, improved cash flow, and better compliance with regulatory requirements.
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echopay EOB Processing Solution automatically extracts data from EOBs and other healthcare-related documents, validates the information against predefined rules, and posts the data to the appropriate patient accounts.
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Yes, echopay EOB Processing Solution can integrate with other healthcare systems, including electronic health record (EHR) and practice management (PM) systems, to ensure seamless data exchange and processing.
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echopay EOB Processing Solution helps increase productivity by automating the manual tasks involved in processing EOBs, freeing up staff to focus on higher-value activities such as exception handling and patient engagement.
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echopay EOB Processing Solution reduces errors by automatically validating data extracted from EOBs against predefined rules and eliminating the need for manual data entry.
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Yes, echopay EOB Processing Solution supports analytics and reporting, giving healthcare organizations real-time visibility into key performance metrics such as productivity, accuracy, and compliance.