Mobile App Reconciling Provider Bills with EOBs
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Solution Overview
Problem
Insured patients face confusion and mismanagement in paying healthcare provider bills due to the asynchronous and unclear nature of Explanation of Benefits (EOBs) and provider statements, leading to uncertainty about the correct payment amount.
Innovation Solution
A mobile app that communicates with a cloud server to process and match provider bills with EOBs using OCR technology, synchronizing data and providing geolocation services to ensure accurate reconciliation and payment processing, allowing patients to pay the correct amount with reduced interaction and increased confidence.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Loss of time
If the provider bills are sent before the EOB, then the patient receives the bill earlier, but the patient cannot know the correct payment amount and may pay incorrectly
Solution Approach 1:
The system performs preliminary action by automatically matching the provider bill with the EOB data before the patient needs to make a payment decision. The mobile application pre-processes both documents, extracts relevant information, and determines the correct payment amount in advance, so when the patient views the matched documents, the correct amount is already identified and presented to them.
Solution Approach 2:
The mobile application serves as an intermediary between the patient, provider bill, and EOB. It automatically extracts data from both documents, matches them together, and presents the reconciled information to the patient. This intermediary system eliminates the need for the patient to manually compare the two documents and determines the correct payment amount.
2Productivity
If the EOB is sent 2-4 weeks before or after the provider bill, then the insurance company can process claims, but the documents become out of synchronization and difficult to match
Solution Approach 1:
The system performs preliminary data extraction and preparation of both the EOB and provider bill documents before the patient needs to review them. The mobile application pre-processes the documents, extracts relevant fields, and presents them in a matched, synchronized view, eliminating the difficulty of manually aligning out-of-sync documents.
Solution Approach 2:
The system creates digital copies of both the EOB and provider bill, extracts key information from each, and presents matched copies to the patient. This allows the patient to view both documents together in a standardized format, making it easy to compare and verify the correct payment amount despite the time delay between receiving the documents.
3Measurement precision
If the patient manually compares the provider bill with the EOB, then the patient can verify the amounts, but the process is complex and time-consuming
Solution Approach 1:
The mobile application performs preliminary extraction and matching of data from both the EOB and provider bill before the patient needs to verify the amounts. It pre-computes the correct payment amount by comparing the two documents and presents this verified information to the patient, eliminating the need for manual comparison while ensuring accuracy.
Solution Approach 2:
The system performs self-service by automatically extracting, matching, and verifying the payment amount without requiring patient intervention. The mobile application independently processes both documents, identifies discrepancies, and determines the correct amount, so the patient simply needs to view the matched documents and confirm the amount.
4Reliability
If the patient calls the insurance company or provider to discuss the bill, then the patient can get clarification, but this increases the workload and delays payment
Solution Approach 1:
The mobile application provides self-service by automatically extracting, matching, and explaining the payment amount without requiring the patient to call the insurance company or provider. The system independently processes both documents, identifies the correct amount, and presents it to the patient with confidence, eliminating the need for phone consultations and accelerating payment processing.
Applied Scientific Principles
This section explains which scientific principles are used to turn an abstract innovation direction into a practical engineering solution.
Function Achieved in This Case
Facilitates timely and accurate payments by synchronizing EOBs and provider bills, reducing user interaction and ensuring healthcare providers receive payments faster, while providing patients with confidence in their payments and access to statistical data on medical costs.
Implementation Method 1
A user of the mobile device receives a healthcare provider bill and obtains a photographic image of the bill
Implementation Method 2
The image of the provider bill is sent to an OCR-processing engine. This may be done locally on the device using a software development kit (SDK) such as that sold under the brand ABBYY MOBILE OCR ENGINE
Data Source
AI summary
A system for validation of healthcare provider bills includes obtaining an image of the bill on a mobile device which uses optical character recognition to resolve the patient, provider and amount due as alphanumeric characters. This collection of data is cross-referenced against an explanation of benefits (EOB) generated by a third-party administrator which relays the portion of the healthcare provider bill covered by insurance versus what is the patient's responsibility. The EOB and provider bill are validated against each other so the patient can make payment in an accurate amount.