Explanation of Benefits

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Explanation of Benefits

In this screen, you can record EOB batches that have been received from insurance providers. The EOB information can then be viewed and analyzed in the Explanation of Benefit report.

 

Topics

How Do I Enter a New EOB Batch?

How Do I Add EOB Items to the Record?

How Do I Post Changes to an Item?

How Do I Void an EOB Batch?

Where Can I View a Report of EOB Batches?

 

 

How Do I Enter a New EOB Batch?

1.Click on the Tools menu item.

2.Select Explanation of Benefits. The EOB screen will open.

3.Click on the New button to enter a new EOB batch.

4.In the Payer field, search for the correct insurance.

5.Enter a Reference # for this EOB batch. (This is the number you will use to search for the batch in the Explanation of Benefit report.)

6.Enter the correct number of EOB items in the Item Count field.

7.In the Payment Date field, you can click on the calendar icon and select the correct date.

8.Enter the dollar amounts for the Total Paid amount and for the Total Fees. (As you enter EOB items for this batch, ProPharm will show a summary of the amounts you have entered alongside these totals. This will allow you to see when you have entered the correct amount for the EOB batch.)

9.You can also enter any necessary Notes.

10.When you are ready, click Save. This will create your new EOB batch. You can then add individual EOB items to the batch.

 

If you need to make changes to the EOB batch, you can click on the Edit EOB button. You can edit the EOB until it has been posted. After the EOB is posted (or voided), no more changes can be made.

 

 

How Do I Add EOB Items to the Batch?

1.After you have set up the EOB batch, you can click on the portion of the screen that says "Click Here to Add EOB Item."

2.You can search for a script in the Rx field. (If the script has multiple fills with payments from the same insurance provider, a pop-up window will appear allowing you to choose the correct one.)

 

If you receive an EOB for a script that already has an EOB record attached to it (e.g., if the insurance company changes the amount being paid) you can use the Post Changes option to amend the record. There will be more information on this process below.

 

3.Enter the correct Date of Service.

4.You can also enter the dollar amounts for the Amount Paid and the Fee.

5.If necessary, you can add Notes.

6.When you have entered the necessary information, click on the Save Item button.

7.After you have saved the EOB item, the current dollar amount that you have entered for this EOB batch will be shown alongside the Total Paid amount. The number will increase as you add more items. Enter all of the necessary items for this EOB.

8.When you have finished entering all of the EOB items, you can click on the Post as Complete button to post the EOB batch. No changes can be made to the batch after it has been posted.

 

 

How Do I Post Changes to an Item?

If you receive an EOB for a script that already has an EOB record attached to it (e.g., if the insurance company changes the amount being paid) you can use the Post Changes option to amend the record.

 

1.After you have set up the EOB batch, click on the portion of the screen that says "Click Here to Add EOB Item."

2.Search for the correct script in the Rx field.

3.After you have chosen the script, click on the Post Changes button. A pop-up window will appear.

4.In this window, you can view all of the bills for this script. If there have been multiple fills for the script with payments from the same insurance, each one will be shown along with the date it was received and the dollar amount. If a change needs to be made to one of these records, select the correct bill from the list and then enter the amount of the correction in the Amount Paid field. (You can enter either a positive or negative amount.)

 

For example, if the current EOB states that the insurance company will be paying $20 less than the amount that was stated on the last EOB, you can select that last record in the pop-up window and then enter "-20.00" in the Amount Paid field. This will update the EOB records for this script, subtracting $20 from the total amount paid.

 

5.After you have made the necessary changes, click Save Item.

 

NOTE: No changes will be made to the script's record unless you select an option in the "Post Changes" window before entering the adjustment.

 

 

You can view changes to the script's EOB information from the Claim Verify window. If an EOB payment has been posted for a fill, additional information will be displayed in the claim details. The payment should be included in the "Total Paid" amount that is shown in the window. The date of the most recent payment will also be displayed in this window as the "Last Posting Date."

 

From there, you will be able to click on the Explanation of Benefits button and view the EOB history for the script.

 

 

How Do I Void an EOB Batch?

If an EOB batch needs to be voided, you can click on the Void button. No changes can be made to an EOB batch that has been Posted as Complete or marked as Void.

 

 

Where Can I View a Report of EOB Batches?

To view details of EOB batches that have been posted, please review the Explanation of Benefit report.

 

See Also

Insurance Claims