explanation of benefits

Also found in: Acronyms.

ex·plan·a·tion of ben·e·fits

(EOB) (eks'plă-nā'shŭn ben'ĕ-fits)
The report from an insurance carrier that explains benefits, deductibles, copayment responsibilities, and reasons for noncoverage of claims.

explanation of benefits,

n a written statement to a beneficiary, from a third-party payer, after a claim has been reported, indicating the benefits and charges covered or not covered by the dental benefits plan.
References in periodicals archive ?
COPE Harris County is accepting proposals from qualified vendors to provide claim check and explanation of benefits printing and mailing services for Community Health Choice, Inc.
MBC offers accurate and updated knowledge on podiatry medical billing, which helps specialists handle problems they face effectively while clarifying to patients complicated Explanation of Benefits and podiatry terms used on their bills.
Preventive processes are those arrangements that discourage or deter fraud, such as the explanation of benefits.
Without the use of any third-party technology,it is fully integratable into a wide array of healthcare applications, including those for Computer Assisted Coding (CAC), Electronic Medical Records (EMR), Explanation of Benefits (EOB) and Claims.
AdminiSource provides electronic and print distribution of Explanation of Benefits (EOB), Explanation of Payment (EOP), Electronic Funds Transfer (EFT), Electronic Remittance Advice (835) and other payment related communications on behalf of healthcare payers and check, ACH transaction and electronic virtual card payment solutions for the purpose of delivering payments from healthcare payers, health plans, third party administrators and other similar entities to providers.
For example, say your office bills an insurance company $1,000 for a procedure, and the Explanation of Benefits statement subsequently arrives with these calculations:
More plans offer online explanation of benefits (55 percent now versus 45 percent in March), and 39 percent of plans now allow members to change physicians online.
West Virginia Division of Rehabilitation Services' vendors can now access payment information online anytime by using the agency's new online Explanation of Benefits service at: http://apps.
The plaintiffs sought to certify several classes, most notably a nationwide class of people whose insurers had a participating provider contract with Quest and who were billed in excess of their stated patient responsibility in an Explanation of Benefits.
eClaim converts Explanation of Benefits (EOBs) documents into electronic images, and captures and merges EOBs, Electronic Remittance Advices (ERAs) and patient payment data into a fully customized electronic posting file for claims re-association, research, and reporting, eliminating the need for data entry.
The system reduces dependence on paper files, telephone calls and faxes for claims, referrals, claims status and processing Explanation of Benefits and paper remittance advice.
If you are frustrated with your inability to appeal denials or to file secondary claims, you should spend some time with your billing staff and learn how difficult it is to keep track of the explanation of benefits (EOB) statements that pour into the office every day.