EOB (Explanation of Benefits) is a statement sent by a health insurance company by paper containing the breakdown of services the insurance company will cover or not. One EOB may include information on claims pertaining to several patients. This will require some manual work in the RCM.
In this article, you'll learn how to:
- Add EOB
- Add Insurance Payment
- Link claims to EOB
- Remove Claim from EOB
- Manage EOB Attachments
- Find Remittance
How to add EOB
1. Go to the Remittance tab and hit +EOB.
2. In the opened window fill in the required fields with all the EOB details you got on paper and hit Save.
3. EOB is created in Unposted status.
Available Remittance statuses:
Unposted
Partially posted
Posted
How to add Insurance Payment
If the remittance has insurance payment you can either create it straight from the Remittance menu or choose the Insurance payment that was created earlier in Insurance payments tab.
To add an insurance payment click Add Payment and choose desired option.
1. To select insurance payment click Select Payment, filter desired payment and click Select.
Insurance Payment will be added to the Remittance.
2. To create an insurance payment click Create an Insurance Payment, fill in all necessary information and click Collect Payment
Insurance Payment will be added to the Remittance.
How to Link Claims to EOB
To track your insurance payments you should link all related claims to that EOB.
1. Go to the Remittance tab, find the desired EOB and click on it.
2. Hit +Add Claim.
3. Since EOB can cover a number of claims, find the one you need, tick the appropriate box and hit Add Claim.
Note: You can search the claim by patient name, DOB, date of service or Claim ID.
You can see all Claims connected to your EOB at a glance by scrolling down the window.
How to Remove a Claim from EOB
You can also remove a claim linked to a remittance.
1. Go to the Remittance tab and click on the date of the remittance that needs your attention.
2. Choose claim you want to remove and Click on Remove in the Claim section.
3. A warning pops up. Confirm your actions - hit Remove.
The remittance will change its status to 'Unposted' or 'Partially Posted'. The last one is possible when at least one payment for the rest of the linked claims remains posted.
How to Manage EOB Attachments
Attach a Copy of an EOB
For records you can attach a paper remittance copy of an EOB to the system.
1. Go to the Remittance tab, find the desired EOB and click on it.
2. You should have your paper remittance image saved to your device. Then click on +Add Files > Select File > Add.
Rules for file selection are:
- you can select more than one file
- accepted file formats are .pdf, .jpeg, .jpg, .png, .xlsx, .xls, .txt
- attachment limit is 10 MB
To view the file, click on it's name.
Delete a Copy of an EOB
Once files are attached to an EOB, you can always get back to them inside EOB > Attachments to open and view. You can even delete them.
1. If you need to delete a copy of an EOB, open the EOB remittance and click on the garbage can icon next to the attachment.
2. When deleting files, the system will ask to confirm your action. If you're sure, hit Remove.
3. The file will be deleted from the EOB.
How to find Remittance
The new EOB will display in the Remittance tab of the RCM. You can find it by applying different filters:
- by received date
- by payors
- by statuses