Monday, February 6, 2017
EOB An explanation of benefits
EOB An explanation of benefits
What is a claim ?
A formal request to an insurance company asking for a payment based on the terms of the insurance policy. Insurance claims are reviewed by the company for their validity and then paid out to the insured or requesting party (on behalf of the insured) once approved.
As we know claims are sent either via Paper or Electronic Transaction EDI 837. Once Insurance Company process the claim, then they will send the payment to the provider(doctor) along with the statement called EOB.
An explanation of benefits (commonly referred to as an EOB form) is a statement sent by a health insurance company to covered individuals explaining what medical treatments and/or services were paid for on their behalf.
Sometime, EOB Used to send communicate their decisions to members regarding payment for services.
Sample EOB
Sample EOB With Copay Amount
Available link for download
