Lido extracts CPT codes, ICD-10 diagnosis codes, patient demographics, provider NPI, and line-item charges from CMS-1500 and UB-04 claim forms, and reconciles each claim against the corresponding EOB or electronic remittance advice. Your billing team sees clean, validated claim data and real discrepancies, not a data entry queue.
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Claims processing involves two parallel data streams: the claim you submit and the payment or denial response you receive. Reconciling them manually, billed amount vs. allowed vs. paid, line by line, for hundreds of claims, is the core bottleneck in medical billing. Lido processes both streams and produces the reconciliation automatically.
CMS-1500 and UB-04 claim form copies arrive as PDFs, from your practice management system, a billing clearinghouse, or scanned from paper. EOBs arrive by mail as paper documents or electronically as 835 ERA files. Lido processes both claim forms and EOBs in the same workflow so the reconciliation data is available as soon as each document pair is complete.
From each CMS-1500 form: boxes 1–33 — patient name, date of birth, insurance ID, subscriber name, group number, provider name, NPI, tax ID, place of service, date of service, CPT codes, ICD-10 diagnosis codes, modifiers, units, and charges per line. From each UB-04 form: patient information, admission/discharge dates, revenue codes, procedure codes, HCPCS codes, diagnosis codes (principal and secondary), and itemized charges. All fields extracted regardless of whether the form was electronically generated or scanned from a paper claim.
CPT and HCPCS codes are validated against standard formats. ICD-10 codes are checked for correct alphanumeric structure. NPI numbers are validated against the 10-digit format. Date-of-service fields are checked for logical consistency (no future dates, no service dates before admission date on institutional claims). Validation errors are flagged before reconciliation so billing staff can identify data entry errors at the claim level, not wait for payer denials.
Lido matches extracted claim data to the corresponding EOB or ERA using claim number, patient ID, and date of service. For each claim line, the reconciliation shows: billed amount, allowed amount, payer payment, patient responsibility, contractual adjustment, denial code, and adjustment reason code. Lines where the allowed amount differs from the expected contracted rate are flagged as potential underpayments for follow-up.
Denied claims are classified by denial reason (CO-45, PR-1, CO-16, etc.) and prioritized by balance amount. Underpayments, where the payer paid less than the contracted rate, are flagged with the expected vs. actual payment. Your billing team receives a prioritized work queue of exceptions, not a pile of EOB PDFs to read through manually.
Upload a batch and get structured output in minutes.
Standard professional claim form used by physician offices, clinics, and outpatient providers. All 33 boxes extracted including diagnosis pointers and service line charges.
Standard institutional claim form used by hospitals, SNFs, and outpatient facilities. Revenue codes, procedure codes, and itemized service charges extracted from all form fields.
Paper EOBs mailed by commercial payers and Medicare/Medicaid. Billed, allowed, and paid amounts extracted alongside denial codes and adjustment reasons.
835 ERA files from clearinghouses processed alongside PDF EOBs in the same reconciliation workflow. Lido reads 835 loop and segment data and maps to the same output schema as paper EOBs.
Claims submitted to secondary or coordination-of-benefits payers after primary adjudication. Primary EOB information is incorporated into the secondary claim record.
Corrected claim forms (frequency code 7) and resubmitted claims after denials. Lido tracks the claim version history and links corrected claims to the original denial record.
A billing specialist receives the Friday EOB batch — 140 claims adjudicated, printed across 60 pages of paper EOBs. Each EOB needs to be matched to the original claim, the payment posted, the contractual adjustment recorded, and any denial noted in the billing system. For denied claims, the specialist opens the claim record, reads the denial reason, decides whether to appeal, and documents the decision. This takes 6–8 hours every week, and that's before addressing the appeals queue from last week's denials.
Lido extracts claim and EOB data in parallel. Payments are matched, adjustments calculated, and denial codes classified without anyone opening a PDF. Your billing specialist receives a prioritized work queue: denials that should be appealed ranked by balance amount, underpayments that exceed your follow-up threshold, and a posting summary for clean payments. The six-hour EOB pile becomes a two-hour exception review.
| Feature | Lido | Manual data entry |
|---|---|---|
| Extract all fields from CMS-1500 and UB-04 claim forms automatically | ✓ | ✗ |
| Match claims to EOBs and ERAs by claim number and patient | ✓ | ✗ |
| Classify denial codes and flag underpayments vs. contracted rates | ✓ | ✗ |
| Validate CPT, ICD-10, and NPI formats before reconciliation | ✓ | ✗ |
| HIPAA-compliant. PHI and claim data deleted within 24 hours | ✓ | ✗ |
| Read the EOB and post each payment and adjustment manually | ✓ | ✓ |
Reconcile claims against EOBs automatically and give your billing team a prioritized exception queue.
A 15-physician multispecialty practice submits 600 claims per week across 8 payer contracts. EOBs arrive across 4 days from different payers. Lido reconciles each claim against the corresponding EOB, flags 34 underpayments against contracted rates, and identifies 12 denials worth appealing, before the billing manager's morning review.
A 200-bed community hospital submits UB-04 claims for inpatient, outpatient, and observation encounters. Revenue code-level reconciliation against 835 ERAs is performed automatically, with DRG payment variances and outlier payments flagged for the hospital billing manager.
A billing company managing claims for 30 physician practices processes claims and EOBs from a centralized billing platform. Lido routes each reconciled claim to the correct practice client and generates per-practice denial and underpayment reports for the weekly billing review.
An infusion center submits high-cost drug claims for biologic therapies. Each claim cycle starts with a prior auth, progresses through claim submission, and ends with EOB reconciliation. Lido tracks the full cycle, from prior auth approval through final payment, and flags claims where payment does not match the auth-approved amount.
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