Manage EOBs

For each submitted claim, an Explanation of Benefits (EOB) document is received from the insurance company along with the insurance payment, if applicable.

Important: If your institution does not use the Auto Remittance module, the EOB is received along with the payment and you must manually add the EOB details to each treatment. If your institution uses the Auto Remittance module, the EOB details are included in the 835 file and are added automatically to each applicable treatment. However, any payments identified as an exception cannot have the EOB details added automatically. In this case, you must still add the EOB details manually.

An EOB uses claim adjustment reasons and remittance advice remarks to explain the logic behind why specific payment amounts were sent for each treatment on the claim. The information included in an EOB may also be used to create secondary EDI insurance claims and for general reporting purposes. When allocating insurance payments to treatments, you can view, enter, and link any EOB details associated with the treatment. When necessary, you can also edit the EOB information.

Example: In some cases, such as adjudication reversals, new information made be made available after the fact and you may need to modify the original EOB to reflect these changes so that accurate information is provided for secondary claims and reporting.

Claim adjustment reasons are standardized HIPAA X12N codes that explain why a claim was adjusted and not paid in full.

Remittance advice remarks are standardized HIPAA X12N codes that give further explanation comments from the insurance carrier on how a claim is adjudicated.

You can perform a variety of tasks to help you manage EOBs.

This can include:

• View EOBs

• Add EOBs

• Edit EOBs