Forms Processing Streamlines Insurance Data Entry Process

Practicare Medical Management, Inc. offers medical billing and accounts receivable management services to more than 50 multispecialty medical practices in New York and New Jersey. A significant portion of Practicare's work involves the daily processing of 100 to 130 explanation of benefits (EOBs) documents and payments sent by insurance companies to healthcare providers. EOBs detail individual services and procedures performed for a patient and the amount the insurance company has paid for each one.

The job of handling EOBs is more complicated than it appears, according to James Antonacci, Practicare's president and CEO. "EOBs have different formats; it is not uncommon for an individual patient's information to vary in length from a few lines to several pages, depending on the number of procedures performed." An EOB may also consist of a single line per claim, one full page per claim, multiple pages per claim, or multiple claims per page, with longer claims running over from one page to another. Plus, each insurance company uses its own EOB procedure and diagnostic codes, format, and rules.