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OVERVIEW
When services are provided to patients, claims for the payment of services are submitted to third party payers (insurance companies, government agencies, 3rd party administrators, etc). Payments are made to the providers in the form of a check or electronic funds transfer. Accompanying the payment is an itemized report of the claims included in the payment. Typically several patients are paid with a single check. The itemized report is then used by the provider to post the payment to each patient’s account. Often the amount received doesn’t fully satisfy the outstanding balance, and requires them to either submit a secondary claim or bill the patient directly for the difference.

The challenge for the health care provider is to create a filing system that allows them to easily retrieve an EOB that lists multiple patients in order to submit a secondary claim or to perform collections for the unpaid balance for a single patient.


THE SOLUTION
FileBound allows you to build a process that minimizes the labor required to file and retrieve EOB documents. After the EOB’s have been posted to the accounting system, they are batched according to how that system processed them (typically posting date or batch ID number). These batches are then scanned and indexed by the batch ID or posting date. The scanned batches are run through an OCR (optical character recognition) process that indexes all the words off of the documents. This allows the provider to lookup a payment in the accounting system to get the batch ID information; they then enter that value into the FileBound system along with a name, amount or claim number and search for the pages within the batch that has this information. Once these pages are found the system allows you to use a “white-out” process (redaction feature found in annotations) to reprint a version of the form that only shows the information for a single patient as mandated within the HIPAA regulations. This is then used as a backup attachment for secondary claims or in collections.

The FileBound EOB solution significantly reduces the labor required to organize, file, retrieve, and reprint these documents. A successful implementation of this solution can then be leveraged to implement a records management solution for other applications.


BENEFITS
  • Significantly reduces labor
  • Solves HIPAA compliance issues
  • Introduces imaging technology that can be leveraged to solve other document intensive applications
  • Quick and simple retrieval
  • Easy implementation with minimal training and support required

DEMONSTRATION
To experience a fully functional demonstration of the FileBound EOB solution:
Go To: http://newwave.filebound.com
Login using: User = Guest,
Password = Guest
Select Project: EOB
Search (Full Text): Mason

To create the document for secondary claims: Click on the SELECT ANNOTATIONS BUTTON on the top tool bar—then select the INSERT ANNOTATIONS drop down selector and select REDACTION. Next draw a box around the portion of the document you want to whiteout. You may have to perform this process multiple times to whiteout text above and below the area you want to include in the printout.


WORKFLOW PROCESS

STEP 1   STEP 2   STEP 3   STEP 4  
Patient services are
provided.
  Health care provider
submits claim to third
party for payment.
  Third party sends
payment and EOB to
provider.
  Provider posts the
payment to each
patient’s account.
 
               
     
STEP 5   STEP 6   STEP 7      
Batches of EOB’s are
scanned, then an OCR
process is run and the
images are uploaded.
  EOB’s are retrieved
and reprinted for
secondary claims and
collections.
  EOB images are
archived on CD-ROM.
     


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