This page highlights all the details in a claim that is in EOB Reconciliation stage.
Encounter ID
The encounter identifier used to link medical records, claims, and billing activity for a single visit.
Status
This status reflects the case’s progress within the current billing stage only (e.g. EOB Reconciliation). It applies to the task assigned to the selected assignee in this tab.
When the assignee completes the task, the case will be marked complete for this stage, but this does not mean the entire claim has been fully processed.
Key Actions
Use these actions to manage the claim:
Recheck Warnings
Recheck the claim to confirm all issues have been resolved before submission.
Defer
Defer the case to be worked on at a later time.
Print
Print the CMS-1500 form.
Message
Send a message about this specific encounter to a member of your team.
Sync
Sync the encounter information with your Practice Portal.
Remove
Remove the claim from the current queue.
Patient Information
This section highlights key patient information, including the patient’s name, Billing Account ID, EHR ID, primary and secondary payers, provider, date of service, and the assignee currently responsible for the case.
Service/Claim/Notes
This side tab provides additional context and detailed information to help you better understand and manage the case.
Service
View service-related details such as surgeries performed, physician notes, clinical documentation from the EHR, operative notes, hospital consult notes, other chart notes, the facility code and name, and the hospital admission date.
Claim
Review key claim information and actions, including submission dates, submission method, and other claim-related details.
Notes
Add notes about the case and document actions taken to keep your team aligned and informed.
Warning Message
Cases in EOB Reconciliation may display a Warning message, indicating that additional review or action is required. The warning message provides details about the potential issue that needs attention.
To learn more about different warnings and errors you may encounter in a claim, please read Warning and Error Messages for EOB Reconciliation.
Charges
This section highlights the total charges to be billed to the payer. It also displays the procedure codes and modifiers associated with the encounter, along with the corresponding units and diagnosis codes.
Payment Summary
This section breaks down charges at the procedure level to help you understand how each service was billed and paid. For each procedure code, you can see the number of units billed, the payer responsible, the original charge, the allowed amount, any adjustments, amounts paid by insurance and the patient, the write-off, and the remaining balance.
EOB
In this section, you’ll see a breakdown by payer and individual EOBs. For each EOB, key details are displayed, including the payment number, payment date, original payer claim ID, and any interest payment.
Each EOB also includes a procedure-level breakdown to help you understand how each service was billed and paid. For each procedure code, you can review the charge, original charge, allowed amount, amount paid by the payer for this payment, the patient responsibility breakdown (copay, coinsurance, deductible), and the associated reason codes. Descriptions for each reason code are listed below.
Use this section to review the information in detail and make any necessary adjustments to ensure the claim is managed correctly.
Submit
Click Submit when you’re finished working on the case to close out the task.