Extract explanation of benefits to structured JSON
Explanation of Benefits documents detail how a claim was processed, what was billed, what the plan paid, and what the patient owes. Every payer formats EOBs differently. Sensible extracts EOB data into validated JSON for claims reconciliation, billing, and revenue cycle management.
Why EOBs break standard extraction tools
Hundreds of payer formats and dense claim-level detail make EOB extraction a normalization problem.
UnitedHealthcare, Anthem, Aetna, and hundreds of regional payers each produce unique EOB layouts. Sensible normalizes all into one schema.
EOBs include CARC and RARC codes explaining payment variances. Sensible extracts and maps these codes per claim line.
A single EOB often covers multiple claims, patients, or service dates. Sensible identifies claim boundaries and extracts each independently.
Fields we extract
Extract any data you need from EOBs into your desired output schema
Patient name, member ID, provider name, claim number, service date(s), payer name, check/EFT number, payment date
CPT/HCPCS code, description, billed amount, allowed amount, plan paid, patient responsibility (copay/coinsurance/deductible), adjustment amount, CARC/RARC codes
Total billed, total allowed, total paid, total patient responsibility, check amount, provider-level adjustments
Medicare Summary Notice detailing Part A and Part B claim processing.
Aetna EOB format showing billed charges, plan payments, and member cost share.
BCBS EOB covering in-network and out-of-network claim adjudication.
UnitedHealthcare Explanation of Benefits with claim detail, allowed amounts, and patient responsibility.
Supported payer formats
Sensible processes EOBs from any commercial or government payer, many of which are available in our healthcare template library. Custom payer configs build in hours.
UnitedHealthcare, Anthem/Elevance, Aetna/CVS Health, Cigna, Humana, BCBS (all affiliates), Kaiser, regional plans
Medicare (MAC-specific formats), Medicaid (state-specific), TRICARE, VA, workers compensation, auto/no-fault
Common Questions
Details on Sensible EOB extraction support.
Yes. Sensible captures check/EFT number, payment date, provider NPI, claim number, and payment totals. For 835 electronic remittances, direct file parsing is more efficient than PDF extraction.
Sensible extracts copay, coinsurance, deductible applied, and total patient responsibility amounts per service line. Remark codes and adjustment reason codes are also captured.
Yes. Sensible extracts CPT/HCPCS procedure codes, ICD-10 diagnosis codes, billed amounts, allowed amounts, adjustments, and payment amounts for each service line.
Sensible processes EOBs from any payer including UnitedHealthcare, Aetna, Cigna, BCBS, Humana, and Medicare/Medicaid. Each payer's format is handled through configurable extraction rules.
Yes. Sensible sends extraction results to your webhook endpoint when processing completes. You can also poll the API for status.
Yes. Sensible flags extractions with low confidence for human review. You can configure review thresholds and workflows.
Sensible is SOC 2 Type II certified and HIPAA compliant. Data is encrypted in transit and at rest.
Documents are deleted after 30 days by default. You can configure shorter retention periods or request immediate deletion via API.
Yes. Sensible offers a free tier with 50 documents per month. No credit card required to start.
Sensible uses per-document pricing for predictable costs. No token-based billing or usage surprises. Volume discounts are available for higher throughput.
Sensible provides REST APIs and SDKs for Python and Node.js. Most integrations take a few hours. Webhooks, Zapier, and direct API calls are all supported.
Sensible processes PDF, PNG, JPG, and TIFF files. PDFs can be native or scanned.
Accuracy depends on document quality and configuration. Most production deployments achieve 95%+ accuracy with proper validation rules and confidence scoring.
Most documents process in 2 to 10 seconds depending on complexity and page count.