EOB and Healthcare Claims Processing Software

healthcare claims processing

Top performing hospital systems and clearinghouses are using intelligent document processing to spend less money on critical tasks like data input, claims processing, integrations, and supply chain logistics.

But the proliferation of new “artificially intelligent” software solutions with vendors who are more focused on hype has muddied the technology waters.

What’s needed today is intelligent connectivity between Payers, Providers, and healthcare claims processing systems. These connective solutions empower B2B data strategy and optimize revenue cycle management.

A New Solution for EOB Processing

healthcare claims processing overview

Onboarding new Payers and Providers is faster now than ever. Gone are the days of hard-coded claim extraction templates. Insurance companies have created over 6,000 different EOB layouts, so hard-coding templates for even 80% of them is not an effective solution.

EOB processing has been forever changed.

This is possible through intelligent document processing, which uses Smart Label Classification to onboard hundreds of EOBs in days, not weeks.

Smart Label Classification classifies documents based on labels within a document, treating them as a “fingerprint.” This method provides reliable classification on complex, semi-structured documents.

4 Healthcare Data Solutions with Grooper:

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Revenue and Payment Cycle Management

Automate EOB and claims processing to integrate data with billing applications to decrease days claims stay in accounts receivable. Process BAI and ACH files along with addendum records (CTX, PPD, and CCD formats) for fast payment processing.

Enhance software applications and B2B data conversions for revenue and payment cycle management solutions. Quickly convert electronic and paper claims into EDI for submission. Return valuable revenue through proactive retrospective denial management.

White Paper: Success for Healthcare Clearinghouses

Learn how healthcare clearinghouse companies are winning by optimizing their data integration. Check out our white paper!

Healthcare Software Integrations

Healthcare Data Integration

Because of the wild variety of forms and information used in insurance claims management, intelligent document processing (IDP) is an effective and proven solution to modernize healthcare claims processing.

Integrate your software applications with existing claims management, billing, RPA, and EMR systems. In addition, with Grooper healthcare claim forms processing, convert CMS-1500 / HICFA and UB paper-based claims into 837 files.

Robust Info Capture for EOBs

Robust Information Capture

The benefit of using IDP is end-to-end healthcare data capture. IDP solutions include robust electronic data ingestion, document scanning, high accuracy OCR, document classification, data extraction, external database lookups, rules-based processing, data verification, and integration with RCM software and process automation solutions.

Grooper supports integration for information capture from standard and custom insurance claim forms, reports, e-signature, email, and electronic paper sources, whether machine or human generated. Process thousands of different EOB formats from multiple Payers and normalize ERA / 835 forms.

Intelligent Claims Processing

Intelligent Claims Processing

Process healthcare claims and EOBs the way humans work. Because IDP uses template auto-builders, onboarding new document types is a streamlined process.

Algorithms intelligently process remark codes and descriptions to flag new Payer specific codes for human review and mapping to standard ANSI codes (or custom overrides) for the 835.

Purpose-built rules engines process data elements on a global, customer, or Payer level. The rules may be as simple as requiring the existence of a data element, or more complex such as requiring data to match a regular expression, or mathematical validation.

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Mini Case Study

In a recent project, one of the U.S.’s largest healthcare data processing companies needed a solution to process B2B data, billing, and insurance claims information for hundreds of thousands of patients. The workload required on back-end systems was massive.

By using intelligent document processing and Smart Label Classification, they transform gigabyte-sized text files into billions of data extractions every day to complete their mission-critical workflows.

Contact us today for faster and easier healthcare claims processing. Because nobody should have to suffer through painful data integrations.

Healthcare Technology Testimonials

  • “The quality and efficiency of work and service delivered was more than we could’ve asked for. It’s always been an easy relationship.”

    Gena Cowan, HIM Manager, Mercy Hospital
  • “We use Grooper for a lot of accounting purposes, and for all the different types of invoices that we process. One of the reasons we like Grooper is that have one application built within Grooper for our whole accounting department. It contains seven different samples of the different kind of invoices we use, depending on if it’s a travel claim, or if it’s repaying a vendor, or something else. Grooper’s able to just recognize everything.”

    Ryan Freeman-Smith, Manger, Oklahoma Health Care Authority
  • “Practically every unit here within our agency uses Grooper on some level. Grooper has cut down on our indexing time by 70 percent.”

    Ryan Freeman-Smith, Manager, Oklahoma Health Care Authority

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