EOB Data
EOBs (Explanation of Benefits)
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 When MRFs and other datasets are inaccurate, incomplete, outdated, or unavailable altogether, FlexPoint can build complete datasets from EOBs alone – ensuring you never lose visibility into how reimbursement rates compare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
Other Consultants
Source
- Explanation of Benefits (EOBs)
- Procured 100% directly from patients
- All-payer databases
Validity
- Validated. Actual EOBs (stripped of PHI) provided to client.
- EOBs can be used as irrefutable concrete evidence in negotiation.
- Unable to validate.
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)
- DOS older than 1-2 years
- Misleading marketing as "refreshed monthly." Data still 1-2 yrs old.
Accuracy
- Accurate. Guaranteed 100%.
- Low level of accuracy. Unable to guarantee accuracy without an EOB.
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
- Outlier thresholds & stop loss %
- 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)
- Not specific - limited to certain Insurers & Providers
- Only show bended market averages for limited range of inpatient and outpatient services
- No insights into Outliers
- Carve-outs - Claim level detail only - Unable to determine / calculate
- Multiple procedure discounts - Claim level detail only - Unable to determine / calculate
Our Process
When we begin work with an organization, we follow a few clear steps to get them what they need. Full project completion can take as little as one (1) to (2) weeks.
Clarify your goals
Whether you’re negotiating contracts, entering new markets, or benchmarking rates - we align our work to your specific needs.
Define Scope
Choose which insurers, providers, and services to analyze - from specific procedures to full rate sheets.
Source & Build the Dataset
We combine a sample of current EOBs collected directly from patients together with MRF transparency data to create a complete, validated dataset.
We have a proven proprietary methodology to recruit patients in small towns, medium-sized cities, and metropolitan areas across the United States. FlexPoint will launch an advertising campaign to reach the local patient population. All advertisements to reach patients are branded with our name. Patients respond to our ads by calling our own internal call center (A+ rated with the BBB - Better Business Bureau) which is comprised of managed care contracting experts and available 7am to 11pm, 7 days per week. Our team screens callers to determine if their medical visits meet our data needs. If so, we compensate the patient with monetary compensation immediately upon receipt of their insurance EOB and other claim documentation. If the EOB does not include DRG / CPT codes (including Provider Tax ID / NPI, and any modifiers, Place of Services codes, anesthesia time units, etc), then FlexPoint will obtain such information with the assistance of the patient and FlexPoint will document the information directly on the EOB. We examine the patient claim documentation to determine the contractual reimbursement rates, summarize our findings, and report the results directly to you.
Deliver Results
You receive a clear, confidential summary of actual reimbursement rates - typically within 1-2 weeks.
Confidentiality
Our style is to discretely perform our work in any market. All of our advertisements to recruit patients are branded with our name and it is never disclosed to patients the identity of organizations to whom we supply our data. Nobody will ever know that we are working for you except for our executive team.
Legal
FlexPoint’s EOB procurement process adheres to the highest level of ethical, legal, and privacy guidelines.
We procure 100% of our EOB claims data directly from patients, who have a legal right to review their information under HIPAA and who have a legal right to provide that information to FlexPoint. We do not obtain any claim information through any agreement with, or directly from, any insurance plans or healthcare providers.