OrboGraph
Building On Interoperability to Facilitate AI Technology Adoption

For healthcare processes to be fully interoperable, documentation and remittance data must be either electronic or in a digital image form. Unfortunately, almost 50 percent of the explanation of benefits (EOB) remittances and almost all correspondence letters are still paper or created as PDF, without any associated metadata. As a result, revenue cycle management (RCM) companies, clearinghouses, medical lockbox providers, billers, and healthcare systems/ providers will manually enter this remittance data into their systems. This process is time-consuming and is fraught with errors. The situation has been further worsened during the COVID-19 pandemic as employees are working remotely.

That’s why many in the industry rely on business process outsourcers (BPO) to complete the data entry task. Associating with outsourced firms presents potential compliance risks in many regards. Additionally, as many BPO employees are now working from home, the chance of data breaches is significantly increased. System resiliency is also an important strategic consideration. The new COVID-19 work rules make any in-person operation questionable for longer-term sustainability. Relying on AI technology and automation will limit the requirements of the human element in processing.

That’s where OrboGraph can help through its multiple approaches to interoperability for data transfer among healthcare stakeholders.

The OrboGraph solution delivers full automation of back-end payment processing via electronification of EOBs, remittances, correspondence letters, and patient payments through the use of data extraction technologies based on AI and deep learning models.

“Interoperability is achieved via a variety of standard and customized technical alternatives. In the case of many OrboGraph clients, the default approach is to push data to the OrboGraph Healthcare Payments Automation Center (HPAC) SFTP server. Other large clients allow HPAC to connect to their servers and initiate the pulling and pushing of pre-processed and processed work,” says Barry Cohen, the Co-President of OrboGraph.

Application program interfaces (API) allow clients to directly integrate into a third party system.

This approach has many advantages because programmatically, it is easiest to control. Additionally, a wide range of rules and functions can be built into this system integration. HPAC provides this capability for those who prefer a programmatic interface.

OrboGraph facilitates interoperability via the use of Large Central Aggregator (LCA) functionality. LCA streamlines file transfer alternatives by providing a single folder location for scanned images. From there, the system automatically splits data into multi-provider concurrent processing queues. After the automated data transfer of PDF or scanned images of explanation of benefit (EOB) forms routed to the OrboGraph HPAC cloud, EOB forms are identified with various layout characteristics and “learned” within the system. The approach automates data extraction, validation, and final output into EDI 835 process. This ultimately results in re-engineered and automated processes, near straight-through processing, higher levels of auto posting, reduced human data entry and balancing, labor/FTE reduction and reallocation, higher quality output resulting in fewer billing errors, and greater patient satisfaction.

To elucidate further, Cohen mentions a case where a clearinghouse began their OrboGraph partnership because of their struggles with a hight cost of paper remit combined with an lack of information sharing between applications. By collaborating with OrboGraph, this clearinghouse was able to convert paper EOBs to ERA and integrate the results holistically into their contract analysis service. This resulted in a direct lift on recovered revenue and improved downstream BI.

In another instance, a Cloud-Based EHR and RCM Service Provider had struggled with their existing offshore BPO vendor. This vendor provided paper EOB conversion to 835 management for over ten years via the use of an extensive data entry network of keyers; an outdated methodology. Orbograph enabled this client to ensure major quality improvements. Postability rates jumped near 99 percent— significantly higher than the BPO vendor. The RCM company will also see significant benefits to its downstream workflows and analytics.

Such has been the prowess that OrboGraph has garnered over the years by continuously enhancing, enriching, and refining both its underlying data extraction technologies as well as the usability of the OrboAccess solutions. “We continue to look for new business processes which can utilize the Opti-Lift solution components,” concludes Cohen.