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Claims document processing

Intake, review, and routing of claims documents that pile up - denials, prior-auth, EOBs, and intake paperwork.

Claims management systemBilling systemDocument managementFax-to-email gatewayPayer portal
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How the workflow runs

5 steps
  1. 1

    Document arrives

    Auto

    Picked up from fax, portal, or email - regardless of source

  2. 2

    Extract data

    Auto

    Structured data extracted from EOBs, remittance advice, intake forms, and prior-auth requests

  3. 3

    Validate

    Auto

    Completeness check - missing fields flagged before review, not after

  4. 4

    Human verify

    Human

    Reviewer confirms extracted data before it enters the claims or billing system

+ 1 more steps

4

Automated

1

Human review

5

Systems connected

The problem

Today this work is mostly manual. People move data between systems, chase approvals, and re-check things that should already be correct.

  • Claims documents arriving by fax, portal, and email - all needing manual review before they enter the system
  • Data entry from EOBs, remittance advice, and intake forms into the billing or claims system - line by line, page by page
  • Routing documents to the right reviewer - often delayed because nobody knows who handles which claim type
  • Rework because a field was missed or a document was incomplete - costing days on appeal timelines

What we automate

The workflow handles the repetitive parts inside the systems you already use. No new tools to learn, no data to re-key.

  • Extracting structured data from documents - EOBs, remittance advice, intake forms, prior-auth requests
  • Validating documents for completeness before they reach a reviewer
  • Routing documents to the right person based on claim type, payer, denial reason, and workload
  • Updating the billing or claims system with extracted data - with a human confirming before it commits

Before and after

Before
  • Claims documents arriving by fax, portal, and email - all needing manual review before they enter the system
  • Data entry from EOBs, remittance advice, and intake forms into the billing or claims system - line by line, page by page
  • Routing documents to the right reviewer - often delayed because nobody knows who handles which claim type
  • Rework because a field was missed or a document was incomplete - costing days on appeal timelines
After
  • Documents move through intake and routing in hours, not days
  • Reviewers spend their time on judgment, not manual data entry
  • Fewer rejections - completeness checks catch missing fields before review, protecting appeal deadlines
  • Audit trail - every document, every extraction, every approval recorded

Where humans stay in the loop

Automation handles the repetitive work. Your people handle the decisions that matter. The line is agreed and signed before launch.

  • Confirming extracted data before it enters the system of record - a person verifies, always
  • Handling illegible or unusual documents - routed to a person, not forced through
  • Decisions on edge cases - incomplete intake, conflicting information, mixed adjudication
  • Sign-off on anything that affects a claim payment or patient account