Health Insurance EOB (Explanation of Benefits) OCR API

EOBs: What They Are and Why They’re Breaking Your RCM.

EOB – Explanation of Benefits
An Explanation of Benefits is the document your health insurer sends after a claim is processed detailing what was billed, what was covered, what was denied, and what the patient owes.
Healthcare organizations process thousands of EOBs every month, yet most still handle them manually by copying deductible amounts, claim IDs, and payment breakdowns into billing systems by hand.
The U.S. healthcare industry spends $83 billion per year on administrative transactions between providers and payers, and there’s a $20 billion savings opportunity waiting for organizations that fully automate manual workflows (CAQH, 2025).

What are the Pain Points?
Nearly 15% of claims submitted to private payers are initially denied and reworking each denied claim costs between $25 and $181 every single time. 41% of providers say at least 1 in 10 of their claims gets denied and most medical group practices have only 40% or less of their revenue cycle operations automated (MGMA, 2024).
Healthcare billing and claims processing contributes to $265 billion in wasted healthcare dollars annually (CNBC / industry estimate). Every misread EOB is a potential underpayment, a billing dispute, or a lost dollar. The pain point is simple: structured data trapped inside unstructured documents, still being processed manually.

Health Insurance EOB: Extracted Fields

Health Insurance EOB API

import requests

url = "https://api.veryfi.com/api/v8/partner/documents"

headers = {

'CLIENT-ID': '<API_KEY_VALUE>',

'AUTHORIZATION': '<API_KEY_VALUE>'

}

payload = {'file_url': 'https://cdn…'}

response = requests.post(url, headers=headers, data=payload)

print(response.json())

What Data Gets Extracted From Every EOB

Veryfi’s EOB parser returns fully structured JSON for every document, giving you instant access to the data that matters most:
• Statement Date (document issue date)
• Amount Saved (total negotiated savings)
• Family In-Network Deductible Used and the Remaining Amount
• Claim Details (Claim ID, Service date, Provider name, Billed amount, Allowed amount, Provider name and other details)
• Member & Plan Information

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US Health Insurance EOB – Fields Supported

Insurance Information
- Insurance Company: Aetna Life Insurance Company
- Plan Name: OA Managed Choice® POS
- Group Name: NEXBRIDGE PEO 2, LLC
- Group Number: 0284731-05-018 B KQZXM4
- Customer Service Phone: 1-800-704-7287
- Insurer Mailing Address: PO BOX 14079, Lexington, KY 40512-4079
Member Information
- Member Name: JOHN DOE
- Member ID: M741629305
- Member Mailing Address: 425 Brannan Street, Apt 301, San Francisco, CA 94107
EOB Summary
- Statement Date: February 28, 2026
- Amount Saved: $228.95
- Family In-Network Deductible Used: $600.00
- Family In-Network Deductible Remaining: $0.00
- Total Family In-Network Deductible: $600.00
Claim Details
- Claim ID: FP82K4WD917
- Patient Name: Sophie (daughter)
- Provider Name: Marcus Holloway
- Network Status: In-Network
- Received Date: 2026-02-19
- Total Amount Billed: $1,735.50
- Total Member Rate: $1,101.55
- Total Plan’s Share: $1,286.65
- Total Your Share: $20.00
- Total Copay: $20.00

Individual Balances
- Medical In Network Deductible: Annual Limit $300.00 | Used $300.00 | Remaining $0.00
- Medical In Network Out of Pocket Maximum: Annual Limit $3,000.00 | Used $1,009.04 | Remaining $1,990.96
- Medical Out of Network Deductible: Annual Limit $1,200.00 | Used $0.00 | Remaining $1,200.00
- Medical Out of Network Out of Pocket Maximum: Annual Limit $6,000.00 | Used $0.00 | Remaining $6,000.00
Family Balances
- Medical In Network Deductible: Annual Limit $600.00 | Used $600.00 | Remaining $0.00
- Medical In Network Out of Pocket Maximum: Annual Limit $6,000.00 | Used $4,091.38 | Remaining $1,908.62
- Medical Out of Network Deductible: Annual Limit $2,400.00 | Used $0.00 | Remaining $2,400.00
- Medical Out of Network Out of Pocket Maximum: Annual Limit $12,000.00 | Used $0.00 | Remaining $12,000.00
Document Information
- OCR Score: 0.977 (97.7%)
- Pages: 3
- Fraud Score: 0 (green)
Document Metadata
- Document ID: 8685204
- Created Date: 2026-03-20 22:13:29
- Updated Date: 2026-03-20 22:13:30
- External ID: null

EOB Automation Across Every Healthcare Workflow Use Case

Revenue Cycle Management Platforms

The Problem:
• Average cost to rework a denied claim: $25.20
• Denial rates exceed 10% at more than half of U.S. healthcare organizations (MGMA)
With Veryfi:
Automate EOB intake and reconciliation at scale.

EHR & Practice Management Integrations

The Problem:
• Manual processing is on avg 70 min per patient
• $90 billion annual cost of routine administrative (Inovalon and CAQH Index)
With Veryfi:
No manual EOB data posting.

Patient Financial Responsibility Tools

The Problem:
• 60% of patients find medical bills confusing
• Delayed payments and provider switching issues(Becker’s Hospital Review).
With Veryfi:
Surface deductible and cost-share data instantly.

Health Plan Audit Automation

The Problem:
• Medicare FFS recorded $31.70 billion in improper payments in FY2024
• Missing documentation and administrative errors, not fraud (cms.gov)
With Veryfi:
Track claim-level payment accuracy across payers.

Insurance Broker Back-Office

The Problem:
• Claims adjudication costs providers $25.7 billion per year
• $18 billion identified as potentially unnecessary waste (Premier Inc., Dec 2025)
With Veryfi:
Automate remittance reconciliation for group plans.

Healthcare Billing Clearinghouses

The Problem:
• $20 billion in potential savings remains untapped
• 70 minutes processing time per patient (2024 CAQH Index)
With Veryfi:
Process multi-payer EOBs without template maintenance.

Trust Matters. Every Patient. Every Document.

We don’t just meet global security standards – we exceed them. As veterans in healthcare data processing, we handle your sensitive information with military-grade security while maintaining lightning-fast processing speeds.

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