Author Topic: Explaniation of Benefits  (Read 2317 times)

williamportor

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Explaniation of Benefits
« on: February 17, 2014, 01:53:09 AM »
Hello Everyone- Could someone suggest to me the best way to obtain Explaination of Benefits (EOBs) statements from insurance companies or other payers. I just signed up a mental health professional that I'm billing for, who is now starting to get paid through my billing efforts, but insists she's not recieveing EOB's. My clearinghouse will send me remit statements (the same info as an EOB), but the client must fill out a seperate form for each insurance company they wish to recieve these remit statements from. EOB information is pretty important for any medical biller. Learning how you folks recieve these EOB's would be a big help.  :)
« Last Edit: February 17, 2014, 01:57:01 AM by williamportor »

PMRNC

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Re: Explaniation of Benefits
« Reply #1 on: February 17, 2014, 09:52:54 AM »
Is the provider receiving checks? or EFT?

Just wondering how they are getting checks with no EOB's if  there is an AOB.  Was there a change to the W4 maybe?
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RichardP

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Re: Explaniation of Benefits
« Reply #2 on: February 17, 2014, 12:15:44 PM »
We bill most of our stuff by printing to paper (some goes electronic).  We are constantly getting notice from our carriers that they are going to stop sending paper EOB's to our client(s), and that the client (or us) must go online and download the electronic remittance advice (ERA) and print it if we want paper copies.  So we are constantly re-sending our form letters explaining that the doctor has fewer than ten employees and wouldn't they please continue sending paper EOB's.  They always do.

This process occurs with each Carrier.  They send paper checks to our clients, but try to stop sending paper EOBs.  They are trying to pass the cost of printing to paper off onto their participating providers.

Blue Cross and Blue Shield of California have a drop-dead date (within weeks) - at which time they will stop responding to contact from their participating providers.  To get needed information, all providers will have to access them through Availity.

So - your client may have a situation where the Carrier is not sending paper EOBs by default.  If you contact them and send the appropriate request, they may send the paper EOBs.  But you may discover that you can no longer contact the Carrier directly - maybe you must contact them through a "gateway" such as Availity.

http://www.availity.com/products/web-portal/
« Last Edit: February 17, 2014, 12:17:37 PM by RichardP »

williamportor

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Re: Explaniation of Benefits
« Reply #3 on: February 17, 2014, 01:01:12 PM »
Is the provider receiving checks? or EFT?

Just wondering how they are getting checks with no EOB's if  there is an AOB.  Was there a change to the W4 maybe?

PMRNC and Richard- Thanks for the feedback, the main problem we're having is with the electronic deposits from payers. Often a deposit is made by Cigna or some other payer in my client's account with no patient name, treatment date, or other information that will allow us to track what claim was paid on. I've called the claims dept. of several insurance companies about this (complete with their beloved automated phone systems), and am normally transferred from one dept. to another, without getting any of my questions answered. I was just wondering if there was a better way of obtaining EOB information on electronic deposits.

DMK

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Re: Explaniation of Benefits
« Reply #4 on: February 17, 2014, 01:12:46 PM »
NaviNet has Cigna and Aetna eob's and claim status as well as patient eligibility and benefits.  It's unfortunate to have to run down claims (even the $0 pay eob's have to be hunted down).

Availity has Blue Cross, Blue Shield.

Our Medicare contractor, Noridian, has a great site.  Often I can get the payment record and eob's prior to them even hitting the bank.

But!  I can hunt up claims, without calling, for most carriers by using their web sites.  The providers will have to let you sign them up on the sites to access their claims.  Their offices should be set up on the sites to check eligibility and benefits anyway.

Some sites are definitely better than others.

Michele

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Re: Explaniation of Benefits
« Reply #5 on: February 17, 2014, 01:36:21 PM »
Most can be obtained on the web somehow.  Then you can match up the deposit amount with the check.  It can be a pain, but it is easier sometimes than getting them from the provider.   :D
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PMRNC

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Re: Explaniation of Benefits
« Reply #6 on: February 17, 2014, 03:11:18 PM »
This is one of the problems with EFT..  I have my clients (all but one) still getting checks and EOB's.  they like it that way, I don't blame them.

The one client I have with EFT setup still has carriers that don't do it, it's inconsistent, sometimes he gets EOB's sometimes he doesn't.. Since I do NOT bill on a %, I'm getting paid for my time because I do have to go and hunt these down.  MOST times the carriers are happy to send you a copy as long as their was an AOB and you are in network.
Linda Walker
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rdmoore2003

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Re: Explaniation of Benefits
« Reply #7 on: February 17, 2014, 04:19:21 PM »
I am going through this same issue with Cigna.    In November 2013, we turned in our paperwork for EFT with cigna.   I received an approval letter the beginning of January 2014 stating that we will start getting EFT payments as of 1/26/14.     THIS HAS NOT HAPPENED.   I am still getting the paper eob's and paper check.   I have called and spoken to cigna and get the runaround.   I even had a provider relations rep tell me that I didnt know what I was talking about,,,,,,I had received a paper eob and check with a date of 2/4/13.  The patient was seen on 1/27/14.   My surprise was that we received the payment so fast.   While I was trying to find out why I am not recieving the eft, I gave her this check information and she said she did not have a claim nor a payment on this patient and that I must have a different insurance company listed, etc etc.    I have way to much to do to continue to track people down and have them do their job.   As long as I continue to get paper checks and eob's, that is fine with me.....
Regina