AI-Driven EOB (Explanation of Benefits) in Healthcare To Declutter Clerical Work: An Introduction

An explanation of benefits (EOB) details a patient’s coverage, the treatment they have received, what the payer covered and did not cover, as well as other pertinent details. While it is not a bill, it is similar to an itemized invoice. With different patients utilizing different insurance companies, larger dental practices, in particular, can become quickly consumed in wrangling data.

Traditionally, specialists manually gather and compile this information from each individual insurance portal. It must be done daily and requires managing multiple secure log-ins in addition to the data being downloaded. After each piece of the EOB puzzle is gathered, it then must be read and sorted, and formats converted where necessary – this may include scanning and uploading digital versions of hard copy documents. The specialist then needs to account for full and partial payments, and appropriately credit patient accounts - all manually. The process then begins again for the next patient.**
**

AI can provide an automated solution to this time-consuming and inefficient process. It would parse EOB continuously and securely, accessing individual insurance portals, pulling EOBs, and recreating them in one, standard, user-friendly format. Specialists could then access it at any time via a dashboard. **
**

Full payments, partial payments, and denials could be clearly delineated with the sum of total daily reports available to specialists for tracking. When access to practice management software is provided, AI that parses EOB might even automatically write-back payment postings to patient accounts. For high-volume organizations, EOB data could also be provided in JSON and CSV formats, expanding automation possibilities.**
**

The key is in utilizing artificial intelligence to identify the appropriate data from the top 25 insurance payor EOBs with a suitably high degree of confidence. Offering documents in multiple format options would also speed optimization.**
**

The benefits of AI replacing manual work include reducing the associated effort, handling time, and cost while increasing work quality (Pragya Jain, American University, February 18, 2021, AI and the Future of Work in the United States).**
**

Additionally, exposure of confidential patient information would be significantly reduced, making it easier for a practice to maintain compliance with The Health Insurance Portability and Accountability Act of 1996 (HIPAA).

Streamlining complex administrative tasks has profound implications for patient care. Technologies like AI, RPA (Robotic Process Automation) could parse EOB for dental practices and reduce the time spent on clerical tasks, freeing practice staff from an endless cycle of paperwork.

By Ato Kasymov, CEO of Zentist

**

**