Capture every input
Extract paper, image and PDF EOBs; parse electronic 835 remittances into a common record.
Healthcare Remittance Automation
EOB Processing Automation
Turn paper EOBs, PDFs and electronic remittance files into validated payment data. Xalta connects document extraction, claim and service-line matching, adjustment coding and posting workflows, with confidence thresholds and human review for unresolved items. Give revenue cycle teams more capacity for denials, appeals and complex reconciliation.
Match at line level
Connect payment and adjustment details to the relevant claims and service lines.
Validate & post
Apply balancing checks and confidence thresholds before the configured posting step.
Route the exceptions
Give reviewers the source context, coding issue and next action for unresolved work.
Revenue cycle operations
Challenges
Remittance work spans payer documents, claims records, adjustment rules and posting applications. When that information is interpreted and reconciled manually, routine transactions compete with the exceptions that need specialist attention. Posting backlogs make account status harder to trust and leave less capacity for follow-up.
Payer formats keep changing
Paper and scanned EOBs carry payment, adjustment and claim details in layouts that differ by payer. Poor scans, multi-page documents and payer-specific terminology make extraction and interpretation inconsistent when each item depends on manual review.
Operational impact: repeated reading, transcription and correction.
Payments must match the detail
A remittance must be connected to the right claim and service lines before the account can be updated reliably. Partial payments, adjustments, missing references and duplicate records create reconciliation work that a document-level total alone cannot resolve.
Operational impact: unresolved allocations and delayed account updates.
Adjustment codes need context
Inconsistent CARC/RARC interpretation and payer-specific adjustment descriptions complicate the handoff into denial, appeal and secondary-claim workflows. Teams need the original remittance context alongside the normalised codes and payment detail.
Operational impact: extra investigation before follow-up can begin.
Routine posting consumes capacity
Teams move between remittance files, claims systems and posting screens while tracking exceptions separately. Low-confidence extraction, unbalanced transactions and posting failures remain difficult to prioritise without a common work item and recorded resolution.
Operational impact: growing queues and less time for complex exceptions.
Healthcare Remittance Automation
How It Works
The workflow separates extraction from validation and posting. Each remittance retains its source, claim references, validation outcome and processing state so an operator can understand what completed, what failed and what needs a decision.
Ingest & extract
Receive digitised paper EOBs, scanned images, PDFs or electronic 835 files through the agreed channel. Apply OCR and document extraction to unstructured inputs and parse existing 835 records as structured data. Capture payer, payment, claim and service-line details with the source references needed for review.
Match & normalise
Match extracted or parsed lines to the available claim and service records. Normalise payer-specific structures, payment amounts and adjustment information, and apply CARC/RARC mapping. Use contract rules where they are included in the agreed scope and the required reference data is available.
Validate & review
Check required fields, payment and adjustment totals, duplicate indicators and reconciliation differences. Apply ST/SE transaction checks when generating EDI 835 output. Use the agreed confidence and business-rule thresholds to release eligible work and send low-confidence, unbalanced or unresolved items to the operator queue.
Post & reconcile
Generate the required EDI 835 output or pass approved payment data into the configured practice-management or RCM workflow. Confirm the receiving system’s result, reconcile the processing status and route posting failures for resolution. Make coded adjustments and denial reasons available to the agreed follow-up workflows.
Solution capabilities
Solutions
Document intelligence, remittance validation and system integration form a connected processing layer. Configure payer mappings, claim matching, confidence policies and posting interfaces around your existing revenue cycle workflow, with a defined route for the items that need review.
Document AI and payer-specific schemas
Multi-format remittance capture
Ingest digitised paper EOBs, images and PDFs, and parse electronic 835 remittances. Extract payer, payment, claim and service-line information into a common data structure. Configure document schemas and field mappings around the payer formats in scope while preserving the source record for verification.
Operational example
Review an extracted payment amount against the scanned EOB before releasing a low-confidence field.
Claims integration and matching rules
Claim and service-line matching
Connect payment and adjustment details to the relevant claim and service lines using available identifiers and client-defined matching rules. Validate the required references and isolate missing or ambiguous matches. Where agreed, incorporate contract data into the matching and validation approach.
Operational example
Assign an unmatched remittance line with its claim reference and payment context to the appropriate reviewer.
Client-defined release thresholds
Confidence and balancing controls
Use extraction confidence alongside mandatory-field, amount, duplicate and reconciliation checks. Define the conditions for automatic release, operator review and reprocessing. Validate transaction integrity and ST/SE structure for generated 835 output before the record enters the downstream posting workflow.
Operational example
Route an unbalanced remittance or a low-confidence service-line amount for review instead of releasing it automatically.
Payer mappings and follow-up routing
Adjustment and denial coding
Normalise payer-specific adjustment information and map CARC/RARC details into the agreed output structure. Retain payment and service-line context so denial teams can investigate the reason for non-payment or adjustment and progress the appropriate appeal, correction or coordination-of-benefits action.
Operational example
Make a normalised denial reason and its original remittance context available to the configured follow-up queue.
Configured output and application connections
EDI 835 and posting integration
Transform validated EOB data into EDI 835 transactions for the agreed downstream workflow, or use the approved integration to pass payment records into the practice-management or RCM system. Capture processing responses and distinguish records sent for posting from those whose downstream result has been confirmed.
Operational example
Generate a balanced 835 file and reconcile its acceptance or rejection in the receiving workflow.
Operator review and payer-level evaluation
Exception console and evaluation
Give operators an assigned queue containing the source, extracted values, failed checks and processing history. Define evaluation cases by payer, document quality and transaction type, covering extraction, mapping, balancing, posting and recovery. Use regression checks when payer layouts, rules or application behaviour change.
Operational example
Track an operator correction through revalidation and confirm that the resolved record completes the downstream step.
Systems and operating scope
Integrations & Configuration
Fit the solution around the systems that hold your claims, remittances and posting records. Xalta defines the intake channels, claim references, payer schemas, output format and receiving-system integration, then configures the review and recovery controls needed to operate the agreed workflow.
A processing framework configured for your payer mix.
Reusable extraction, validation and orchestration components provide the foundation. Your document layouts, reference data, receiving applications and operating rules define the configuration and any additional work.
| Workstream | Reusable components | Client configuration | Additional scope |
|---|---|---|---|
| Inputs and extraction | Document ingestion, OCR, extraction and structured remittance processing. | Intake channels, payer schemas, required fields, document quality checks and confidence thresholds. | New document families, specialist layouts or additional intake applications. |
| Matching and validation | Normalisation, claim and line matching, balancing and exception handling patterns. | Claim references, matching rules, adjustment mappings, duplicate checks and review thresholds. | Additional reference systems or specialised contract and reimbursement logic. |
| Output and posting | EDI transformation, workflow orchestration and downstream response capture. | 835 output requirements, practice-management or RCM interfaces, posting rules and reconciliation states. | Additional receiving systems, bespoke posting screens or wider claims-process automation. |
| Operations and evaluation | Review queues, transaction history, operational status and regression-test patterns. | Reviewer roles, exception ownership, payer-level evaluation sets, escalation and retention requirements. | Extended dashboards, additional review applications or broader service coverage. |
Representative remittances
Provide de-identified examples across the payer layouts, input quality levels and exception types in the initial scope, with expected extraction and posting outcomes.
Reference data and access
Confirm claims and service-line references, payer mappings, contract rules where required, and approved access to the practice-management or RCM workflow.
Release and review rules
Agree confidence thresholds, reconciliation checks, reviewer ownership, acceptance measures, posting windows and recovery procedures before controlled rollout.
Remittance processing and payment posting
Use Cases
Apply the workflow to scanned EOB conversion, claim-level remittance reconciliation and approved payment-posting integration. The targets below guide discovery and acceptance planning; they are validated against the eligible transaction mix, payer coverage and receiving-system constraints agreed for the deployment.
Deployment target
95%+Auto-post rate target
Proposed target for eligible remittance transactions that pass the agreed matching, confidence and validation rules. Confirm the denominator and measurement period at scoping.
Deployment target
80%Manual-effort reduction target
Proposed reduction against the agreed manual posting baseline. Measure comparable volumes and exception types during the controlled pilot.
Deployment target
<24 hrPosting turnaround target
Proposed service target from agreed intake to confirmed posting. The final SLA, service window, dependencies and exception treatment are defined in the engagement.
Documented implementation · Healthcare RCM
Healthcare revenue cycle operations
Scanned EOBs converted into validated EDI 835 workflows.
Operating context
A healthcare revenue cycle operation faced manual EOB handling, more than 3,000 payer-specific format variations, inconsistent adjustment interpretation and delays in reconciliation and downstream posting workflows.
Implementation
Xalta combined OCR and document extraction with payer-data normalisation, CARC/RARC interpretation, remittance reconciliation and EDI 835 generation. The workflow applied segment-level validation and ST/SE balancing, detected missing payments and duplicate or unmatched claims, and routed unresolved items for review before downstream processing.
Documented outcomes
- The case study reports EOB processing turnaround reduced from days to seconds.
- Near 100% straight-through processing was reported for standard remittance workflows in that implementation.
- Improved first-pass posting and reconciliation accuracy, with less manual effort in payment posting and denial handling.
Delivery and operations
Implementation & Support
Start with the payer groups and posting workflow that account for the most routine work. Establish a baseline, configure the extraction and validation rules, and evaluate both normal and exception scenarios before expanding the release. Operating ownership and change handling remain part of the delivery scope.
Assess payer workflows
Map input channels, payer layouts, claims references, adjustment handling and posting steps. Establish the eligible transaction population, manual baseline, exception categories and success measures for the initial rollout.
- Xalta delivers
- Workflow map, payer priorities, integration assessment and measurable acceptance criteria.
- Your team provides
- De-identified remittances, process owners, current handling times and posting or reconciliation rules.
Acceptance checkpoint
The payer groups, workflow boundaries, dependencies and target measures are agreed.
Configure & connect
Configure document schemas, claim and service-line mappings, adjustment coding and balancing rules. Connect the agreed RCM or practice-management workflow and establish confidence-based release, review and downstream result handling.
- Xalta delivers
- Configured extraction, matching, validation, output and operator-review workflows.
- Your team provides
- Approved access, claim reference data, payer rules and designated reviewers.
Acceptance checkpoint
The workflow is ready to exercise representative and exception scenarios end to end.
Evaluate & launch
Build a payer-level evaluation set, with 200+ remittance variants as an initial coverage target. Test extraction, matching, coding, balancing, posting and recovery. Release controlled batches and reconcile the outcomes before widening the eligible scope.
- Xalta delivers
- Evaluation results, reconciliation evidence, user walkthroughs and a staged release plan.
- Your team provides
- Expected outcomes, business review, acceptance decisions and release authorisation.
Acceptance checkpoint
The agreed evaluation and posting criteria pass for the payer groups included in the release.
Monitor & improve
Track posting outcomes, review queues and recurring exceptions. Assess new payer layouts and changes to mappings, rules or receiving applications. Re-run the relevant evaluation cases before releasing material configuration changes.
- Xalta delivers
- Monitoring, incident triage, regression checks and change handling within the contracted scope.
- Your team provides
- Operational ownership, exception decisions and approval of changes or expanded payer coverage.
Acceptance checkpoint
Review ownership, escalation, service measures and change responsibilities are established.
Documented client work
Case Studies
A healthcare remittance implementation and related finance workflows show how document intelligence, validation, review and system integration support operational processing.
Healthcare · Revenue cycle management
EOB payment posting
Near 100% straight-through
Standard remittance workflows in the documented implementation
OCR-based extraction, payer normalisation and remittance reconciliation produced validated EDI 835 transactions. Balancing checks and exception routing supported downstream claims and payment-posting operations.
Read case study
Oil & gas · Accounts payable
Vendor invoice processing
70% less manual effort
Reported for the documented client workflow
Document extraction and vendor-specific validation rules connected DocVue with OGSQL/OGSYS. The workflow automated accounting entries while retaining approval steps, exception ownership and fallback handling.
Read case study
Financial services · Document operations
UCC filing and attorney invoices
Connected to the ERP
Republic Finance implementation
Reusable extraction and form-generation components supported state-specific UCC submission. A connected attorney invoice process applied business and accounting rules, with non-conforming transactions routed to review.
Read case studyPlanning your deployment
FAQs
Key questions about payer coverage, remittance formats, posting integration, review controls and implementation scope.
Which remittance formats can be included?
The scope can include digitised paper EOBs, scanned images, PDFs and electronic 835 remittance files. OCR and document extraction are applied to unstructured inputs; existing 835 data is parsed as a structured transaction. Intake channels, scan-quality requirements, payer layouts and output formats are confirmed against your sample set during scoping.
How are payments matched to claims and service lines?
The workflow uses available claim and service references with client-defined matching rules. Extracted payment and adjustment details are normalised before matching and validation. Contract rules can be incorporated when included in scope and supported by the required reference data. Missing, ambiguous or conflicting matches are retained for review with their source context.
Does every remittance post automatically?
Automatic release applies to eligible transactions that pass the agreed confidence, matching, balancing and business-rule checks. Other items go to an assigned review queue. The 95%+ auto-post rate and 80% manual-effort reduction are proposed deployment targets that must be evaluated against your transaction mix and baseline. The under-24-hour posting target becomes a service commitment only when the SLA and its dependencies are agreed.
How are denials and adjustment codes handled?
The solution can normalise CARC/RARC information and payer-specific adjustment descriptions while retaining the original claim, service-line and payment context. Configured routing makes that information available to denial, appeal, correction or coordination-of-benefits workflows. Coding mappings and the actions that require a reviewer’s decision are established with your revenue cycle team.
Can it work with our practice-management or RCM system?
Xalta assesses available interfaces, claim-reference access, output requirements and operating constraints before agreeing the integration. The workflow can generate validated EDI 835 output or use the approved application connection for payment processing. The scope defines how acceptance, rejection and posting status are captured and reconciled with the remittance work item.
How many payer formats are supported?
Coverage is defined by the payer groups, document layouts and transaction types in your deployment. An initial evaluation plan can target 200+ remittance variants, prioritised by volume and operational impact. The documented healthcare case addressed a landscape of more than 3,000 payer-specific EOB variations. Your supported coverage is established through representative testing and acceptance for the formats included in scope.
How are sensitive data and operator access handled?
Deployment planning defines the environment, approved access, credentials, reviewer roles, retention and audit requirements for your organisation. Operators receive the source context and processing information required for their assigned work. Security, privacy, contractual requirements and the applicable handling of healthcare information are confirmed with your team before data access or rollout.
What happens when posting fails or a payer changes its layout?
The workflow retains the failed processing state and receiving-system response, assigns the next action and reconciles the downstream result before retrying. Changes to layouts, mappings or business rules follow the agreed change process and relevant regression checks. Implementation and support costs reflect payer coverage, integrations, review needs, transaction volumes and the agreed operating service.
Discuss your remittance workflow
Contact Us
Bring representative EOBs, your priority payer groups and the posting applications your team uses. We will walk through extraction, matching, validation and review, then define the integration scope, evaluation approach and operating targets for an initial deployment.