Automatic, pain-free EOB and claim reconciliation.
Medical cardiopulmonary rehabilitation center/clinic with two locations in Texas
This clinic, like many, dealt with the risk by assigning more people to it: eight full-time staffers (with two open positions) spent their days manually reviewing 4,200+ EOB documents each month — a mix of paper and electronic images — and checking amounts against open claims from the clinic’s billing software to ensure the net payment matched the expected billing amount.
EOB documents often included multiple patient ICN codes that needed to be extracted as individual line items. At best, this manual reconciliation took 8 days and the team was stretched.
Challenges:
Staff had to manually examine and process a large volume of EOB documents (paper and electronic) monthly.
Manual reconciliation took a significant amount of time, impacting efficiency and productivity.
The team was stretched thin due to the high volume of work and limited resources.
EOB documents often contained multiple patient ICN codes, requiring additional manual processing.
The clinic had two open positions, further straining the existing staff and hindering efficiency.
Solution:
Each line item is extracted and a digital workflow checks the billing system to match the amount received with the balance.
Since most EOBs underpay the claim, Process Matters™ developed a table of automated rules that lets the system compare allowed deductions per each insurance plan and then determine whether to accept the amount received based on those rules, or route the exception to a specialist for additional review.
Amounts are then imported into billing software to automatically bill patients on open balances.
By reducing the number of FTEs managing exceptions and claim reconciliation and leaving open positions unfilled
To complete EOB and claim reconciliation and bill patients faster: from 8 days to less than 2 days
in late filing charges and lost revenue caused by delays in billing client for services.
A massive win for data processing accuracy and speed.
Major municipal housing and community development agency
Their existing data capture partner scanned the forms and extracted handwritten data using single-pass verification, but typically only achieved 65% accuracy. A team of 4-6 full-time city employees worked to fix the errors and key in correct information from captured images across six different types of housing forms.
The city fell weeks behind in their form reconciliations, leading to fines being levied on landlords for overdue documents. Disgruntled landlords who had submitted their forms on time called to challenge these fines, creating additional customer service burden for the city.
Challenges:
Processing over 200,000 multipage, handwritten forms monthly was overwhelming for existing systems.
Single-pass verification achieved only 65% accuracy, leading to significant data errors.
A team of 4-6 employees had to manually fix errors and key in correct information, which was time-consuming and prone to further mistakes.
The high error rate and manual process caused significant delays in reconciling forms, resulting in fines being levied on landlords.
Disgruntled landlords challenged the fines, creating additional workload and frustration for the city’s customer service department.
Solution:
Using a sophisticated OCR/ICR engine to lift printed and handwritten data — even unstructured data — and pairing it with a double-blind human verification process, Process Matters™ has consistently achieved greater than 99% accuracy since the city transitioned the business away from its previous provider.
Documents are automatically routed to one of six different departments based on classification rules. The city’s throughput skyrocketed and they were able to reconcile reports in under 48 hours through automated data posting, reducing landlord complaints and incorrect fine rollbacks. City employees can spend time on higher-value tasks instead of data error resolution.
Across 200,000+ forms monthly, reducing employee need for error handling.
Automated posting of data to the city’s document repository enables reconciliation within 48 hours, instead of weeks.
Improved relationships with landlords and decreased customer service burden due to reduction of improper fines.
Finding more dollars without adding more people
Regional professional manufacturer’s representative for restaurant equipment
Reconciling customer quotes with purchase orders, turning the POs into manufacturer orders, and then tracking commission rates for sales it makes against contracted agreements and orders placed is critical to ensuring the company receives its fair cut of sales.
Each month, eight employees manually combed through paper reports with thousands of invoices and items to reconcile commission amounts paid against contracted agreements and dispute errors with manufacturers. It often took an entire month.
Challenges:
Eight employees had to manually review thousands of invoices and items each month to reconcile commission amounts.
The manual process often took an entire month to complete.
Manual reconciliation is prone to human errors, which can lead to inaccurate commission calculations and disputes with manufacturers.
A significant portion of the company’s resources were dedicated to manual reconciliation tasks.
Tracking commission rates against contracted agreements and orders placed was complex and time-consuming.
Solution:
First, it created a system to digitally receive and process customer POs and reconcile them against quotes for accuracy and changes. The PO, consisting of orders for several different manufacturers, is split and orders sent to appropriate brands.
Secondly, Process Matters™ created a data extraction and workflow process to take each month’s commissions report, pull out every invoice and line item, and check the commission rate paid against the contracted amount for each item stored in a database.
Exceptions are flagged and for staff review. Reconciliation now takes just hours.
The company reduced by 80-90% the employee time spent reconciling commission reports. FTEs down from 8 to 2, who now just handle exceptions.
Increased accuracy in quote-to-PO verification across 800 orders per month. Redeployed 6 FTEs who were solely focused on this task before.
Digitization has surfaced vast performance data previously unseen, like quote conversion rate and item profitability. Available data in analytics dashboards will help to further boos performance.
We operate in variety of industries. See how we can help your business increase efficiency and save time and money.
Accurate, automated business processes that save time and money.
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Email: [email protected]
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Corporate Office
6424 E Greenway Pkwy
STE 100
Scottsdale
AZ 85254
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Process Matters™ ©2024 All Rights Reserved
Corporate Office
6424 E Greenway Pkwy
STE 100
Scottsdale
AZ 85254
Process Matters ©2024 All Rights Reserved
