Healthcare claims (USA) — document capture template

Medical claims intake: CMS-1500 professional and UB-04 institutional claim forms are classified; patient, member ID, billing provider NPI (check-digit validated), dates of service, diagnosis codes and total charges are captured. Explanation of Benefits letters are recognised too. Every batch is verified by a second person.

At a glance


Region	USA
Industry	Healthcare
Document types	CMS-1500 claim, UB-04 claim, Explanation of benefits
Workflow	Scan → OCR, separation & classification → Classification → Extraction & validation → Index / Validate → Double-key verify → PDF generation & export
Straight-through processing	No — every batch is checked on screen
Separation	each file, change of document type
Output	searchable PDF with XML, JSON data
Dates read as	MM/dd/yyyy, M/d/yyyy, MM-dd-yyyy

Use this template

Go to Batch Setups and choose New Batch Setup.
Filter by USA or search for "Healthcare claims (USA)", select it and choose Next.
Name the Batch Setup, choose the export folder and create it.
Try it with a few of your own documents on the Test tab, adjust fields and rules, then publish it — see Test a Batch Setup and Versions and publishing.

Batch fields

Entered once per batch, for example on the Scan screen.

Field	Type	Required	Found by	Checks
Batch reference	Text		entered by the operator

Document types and fields

CMS-1500 claim

Recognised by words such as "health insurance claim form", "1500", "NUCC".

Field	Type	Required	Found by	Checks
Patient name	Text	Yes	label "Patient's name", "Patient name", "Patient"
Patient date of birth	Date	Yes	label "Patient's birth date", "Birth date", "DOB"	Not in the future
Insured's ID number	Text	Yes	label "Insured's ID number", "Member ID", "Subscriber ID"
Billing provider NPI (box 33a)	Text	Yes	pattern in the text	NPI number
Date of service from	Date	Yes	label "Dates of service", "From", "Statement covers period"	Not in the future
Diagnosis codes (ICD-10)	Text		pattern in the text
Total charges	Amount	Yes	label "Total charge", "Total charges"	at least 0

UB-04 claim

Recognised by words such as "UB-04", "CMS-1450", "revenue code", "NUBC".

Field	Type	Required	Found by	Checks
Patient name	Text	Yes	label "Patient's name", "Patient name", "Patient"
Patient date of birth	Date	Yes	label "Patient's birth date", "Birth date", "DOB"	Not in the future
Insured's ID number	Text	Yes	label "Insured's ID number", "Member ID", "Subscriber ID"
Billing provider NPI (FL 56)	Text	Yes	pattern in the text	NPI number
Date of service from	Date	Yes	label "Dates of service", "From", "Statement covers period"	Not in the future
Diagnosis codes (ICD-10)	Text		pattern in the text
Total charges	Amount	Yes	label "Total charge", "Total charges"	at least 0

Explanation of benefits

Recognised by words such as "explanation of benefits", "this is not a bill", "allowed amount".

Field	Type	Required	Found by	Checks
Member ID	Text	Yes	label "Member ID", "Subscriber ID", "ID number"
Claim number	Text		label "Claim number", "Claim #", "Claim ID"
Patient responsibility	Amount		label "Patient responsibility", "You may owe", "Amount you owe"	at least 0

Adapt it to your documents

Add or rename fields and change how they are found: Fields and data extraction, Finders and zones.
Improve document type recognition: Document classes and classification, Samples and classifier training.
Send the documents and data to your systems — folders and servers, SharePoint, Google Drive and other cloud drives, S3, document management (FileNet, Alfresco, M-Files, DocuWare), SAP, Dynamics 365, Salesforce, Xero, QuickBooks, SQL, REST or a C# script: Output and export, Cloud and business-system destinations.
Arrange the data entry screen: Screen designer.

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