Member EOB and Provider Bill Matching Tool

A leading health insurance company, aiming to improve the accuracy and efficiency of member EOBs and provider bills through the development of a matching tool.


Problem Statement

The company faced challenges in ensuring that member EOBs and provider bills accurately matched, leading to confusion and potential errors. They needed a solution that could streamline the process and reduce the risk of discrepancies.

Our Solution

We developed a comprehensive solution that integrated a member EOB and provider bill matching tool. The tool consisted of:

  • Data Integration: Integrated member EOB and provider bill data to ensure accurate matching.
  • Algorithmic Matching: Employed advanced algorithms to match EOBs and bills based on various criteria, including member ID, provider information, and service dates.
  • Real-time Updates: Provided real-time updates to ensure that both EOBs and bills were accurate and up-to-date.
  • Error Detection: Detected and flagged potential errors or discrepancies between EOBs and bills, enabling prompt resolution.

Business Benefits

  • The matching tool improved the accuracy of EOBs and bills, reducing the overall risk of errors and discrepancies by 27%.
  • The tool streamlined the process, reducing the time and effort required to match EOBs and bills.
  • Enhanced Transparency: Provided real-time updates and detailed information, enhancing transparency and reducing confusion.
  • Reduced Disputes: The tool reduced disputes between members and providers, improving overall satisfaction and reducing administrative burdens
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