Explanation of Benefits
Explanation of Benefits Meet the need for speed and transparency in worker compensation claims.
EOBs are complicated, requiring careful correspondence between employers, employees, healthcare providers, and insurance providers. Injured individuals depend on government processes to access wage replacement and medical services. ILINX innovation enables your agency to serve everyone’s requirements more efficiently by driving processes with intelligent workflows and leveraging AI to compare contracts and supplemental documentation against state-specific laws.
Technical Highlights
- Leverage AI to understand claim details and reconcile them against state-specific laws
- Drive content understanding with Natural Language Processing (NLP) and descriptive logic
- Process incident reports and other documentation without creating templates
- Convert handwriting to machine-readable text
- Route information to stakeholders and through processes with intelligent workflows
Process Claim Documentation
ILINX Advanced Capture AI facilitates document understanding in contracts, government policy documents, provider services, and medical bills. It rapidly identifies, captures, and indexes critical data—even from semi-structured documents—without requiring time-consuming template creation or individual code matching.
Expedite Determinations with AI
Automate the comparison of claims information and supporting documentation against your state’s benefits structure. ILINX AI accelerates the analysis of key information, including the details of the incident, to assess whether the injury is covered under workers’ compensation laws.
Calculate and Explain Benefits
Once approved, ILINX intelligently compares claim information against state laws to establish what treatment and compensation the worker is eligible for. It generates an Explanation of Benefits for stakeholders, clarifying the determination, services rendered, amount paid, and remaining responsibility.
Real-World Applications for Explanation of Benefits
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Appeals Processing
Document and support determinations with relevant state laws for claims appeals processes.
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Payment Reconciliation
Healthcare providers can use EOB information to accelerate the reconciliation of payments and remaining balances.
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Third-Party Administration
Rapidly and accurately capture EOB details to manage claims processing and healthcare benefits on behalf of self-insured employers and organizations.
