EOBs are “The GOLD Standard” for determining contractual allowed amounts negotiated between Insurers & Providers.
100% Guaranteed: The most Accurate and Current reimbursement data available in the market.
EOBs are a critical tool for validating Machine-Readable Files (MRFs) and other datasets. When MRFs and other datasets are inaccurate, incomplete, outdated, or unavailable altogether, FlexPoint can build complete datasets from EOBs alone – ensuring you never lose visibility into how reimbursement rates compare across insurers and providers.
Whether you’re verifying existing data or filling critical gaps, EOBs allow us to deliver a level of accuracy and completeness no other method can match.
Why FlexPoint EOB Data is Unique:
Data Attributes
FlexPoint Data
Source
Explanation of Benefits (EOBs)
Procured 100% directly from patients
Validity
Validated. Actual EOBs (stripped of PHI) provided to client.
EOBs can be used as irrefutable concrete evidence in negotiation.
Age / DOS
Current. Guaranteed more current than any other data source.
DOS within last 30 days
DOS time period customization available (last 1, 3, 6, 12, 18, 24 months)
Accuracy
Accurate. Guaranteed 100%.
Granularity
Specific - any Insurer (by product e.g. PPO vs. HMO)
Specific - any Provider (Tax ID / NPI specific)
Actual reimbursement methodologies per insurer contract
Inpatient - DRG Base Rate, Case Rate, Per Diem
Outpatient – Case Rates, Fee schedule, % of charges, APCs, etc
Carve-outs – Implants, Drugs, CT / MRI in Emergency Room, etc.
Surgery – Discounts for multiple procedures (eg. 100%/50/25/0)
