EOB processing turnaround
Reported for the EOB-processing workflow.
Client case study
Automating EOB Processing & Payment Posting
Xalta automated the preparation of healthcare remittance data from paper and scanned explanations of benefits. The workflow extracts line-level information, validates balances and produces EDI 835 files for downstream posting, with unresolved items routed for review.
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Results at a Glance
Reported results for the workflow described below.
Standard-workflow straight-through processing
Reported for standard remittance workflows.
EDI 835 output
Automated balancing and integrity checks improve transaction quality.
Exception review
Operations teams can focus on complex reconciliation and coordination cases.
Client & project context
Client and Project Overview
The client operates in healthcare revenue cycle management and processes paper and scanned EOB documents across more than 3,000 payer-specific format variations. Differences in layouts and adjustment information made consistent payment preparation difficult.
The project connected document ingestion, line-level extraction, remittance normalisation and EDI 835 generation. The resulting records support downstream claims and payment-posting workflows while preserving an exception path.
The challenge
Operational Challenges
The team needed to turn highly variable payer documents into consistent remittance information before the data could support reliable posting and follow-up.
Payer Format Variation
Thousands of document layouts made manual reading and standardisation difficult to scale.
Adjustment Interpretation
Payer-specific adjustment patterns and reason codes required consistent mapping.
Reconciliation Differences
Missing payments, duplicate claims and unmatched adjustments created additional review work.
Downstream Processing Delays
Unstructured source information slowed payment preparation and coordination of benefits work.
The solution
Solution Overview
The automation combines document intelligence, structured validation and EDI transformation to prepare consistent remittance output.
OCR and AI-based extraction read the EOB information. The workflow normalises payer structures, checks transaction integrity and maps validated records into the segments required for downstream remittance handling.
Line-Level Extraction
Capture claim, service, payment and adjustment details from the supported EOB layouts.
Adjustment Normalisation
Interpret and standardise payer-specific adjustment and reason-code information.
Balancing and Reconciliation
Check transaction structure and detect missing payments, duplicates or unmatched amounts.
EDI 835 Preparation
Generate validated remittance files and synchronise the relevant downstream workflow records.
Human Review and Operational Control
Revenue cycle specialists review unresolved adjudication, reconciliation and coordination of benefits cases. Automated interpretation prepares and routes the work; it does not replace the team’s authority over disputed or ambiguous records.
How it works
Workflow and System Integration
The stages below show the implemented process from source information to output or review.
- 01
Receive and Classify EOBs
Bring paper scans and image documents into the remittance-processing workflow.
Document ingestion - 02
Extract Remittance Details
Read claim, service-line, payment and adjustment information.
OCR + document AI - 03
Normalise Payer Information
Standardise payer-specific structures and reason-code interpretation.
Remittance mapping - 04
Validate and Reconcile
Check structure, balances, duplicate claims and missing or unmatched payments.
Validation + reconciliation - 05
Route Complex Cases
Send unresolved adjudication and coordination cases to the responsible team.
Exception review - 06
Generate Posting Output
Create EDI 835 transactions and synchronise supported downstream records.
EDI 835 + claims platforms
Implementation
Implementation and Delivery
The implementation connected extraction, payer-specific mapping and structured output validation around the remittance workflow.
Support Payer Variations
Apply extraction and normalisation logic to the supported EOB document structures.
Validate the Remittance Record
Check required transaction segments, adjustment information and balancing before downstream use.
Connect Output and Review
Generate EDI 835 files and route unresolved cases to operations for follow-up.
Payer-Specific Exceptions
Standard remittance cases and complex coordination or adjudication cases require different handling. Unresolved records remain in the review path.
Platforms, Technology and Architecture
Each component has a defined role in processing, validation, integration or review.
- Input
EOB ingestion and classification
Brings supported paper scans and image documents into processing.
- Extraction
OCR and AI-based document models
Reads claim, service and adjustment information.
- Validation
Remittance and balance checks
Validates segment information and reconciliation consistency.
- Output
ANSI X12 835 transformation
Maps prepared remittance data to the downstream transaction format.
- Integration
Claims and revenue cycle systems
Receives the output and supports exception and follow-up workflows.
Results & business impact
Results and Business Impact
The reported improvement combines faster EOB processing with near-total straight-through handling of standard remittance workflows. Complex cases remain visible to the operations team.
| Workflow measure | Before | After | Reported result |
|---|---|---|---|
| Processing turnaround | Paper and scanned documents required manual interpretation and preparation. | Extraction, normalisation and validation prepare the supported remittance records automatically. | Days to secondsEOB processing turnaround |
| Standard remittance processing | Routine remittance handling depended heavily on manual work. | Supported standard cases proceed through the defined automated path. | Near 100%Standard-workflow straight-through processing |
| Output integrity | Remittance structures and adjustment interpretation varied by payer. | Normalised data is mapped into EDI 835 transactions with balancing checks. | ValidatedEDI 835 output |
| Team workload | Routine data handling competed with complex payment and claim exceptions. | Unresolved adjudication and reconciliation items are separated for specialist review. | FocusedException review |
More Consistent Posting Inputs
Normalised fields and balancing checks improve the quality of remittance information passed downstream.
Capacity for Complex Work
Less routine document preparation allows specialists to focus on unresolved payments, denials and coordination cases.
Related offerings
Related Solutions and Services
Explore the solution, supporting service and industry context for this workflow.
EOB Processing Automation
Prepare validated remittance records for downstream posting.
AI Agents & Document Processing Services
Extract and validate information from complex business documents.
Healthcare & Life Sciences Automation
Connect administrative workflows across healthcare operations.
Discuss a Similar Requirement
Bring a sample of your EOB formats, posting requirements and exception categories. We can define the extraction, validation and review steps needed for your workflow.
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