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Reporting EOB's

The Fiscal Agent will need to receive and process remittance information for claims being billed to commercial insurance before those claims are able to move forward to be billed to Medicaid or the Escrow account.  Because the Fiscal Agent will only receive remittance information from some commercial insurance companies, providers will enter their Explanation of Benefits (EOB's) directly into before faxing the EOB to the Fiscal Agent at 1-518-836-0400.  Only EOB's that have not been received by the Fiscal Agent need to be entered and/or sent.

Please note that expedited payment agreements from Multiplan are not EOB's.  Providers who have accepted agreements with Multiplan need to wait for an EOB directly from the insurance company to enter any payment or denial information.

Please note that returned claims or a notice that claims were sent to the incorrect address or branch of an insurance company are not EOB's.  Please see this Knowledge Base article for more information on how to proceed.

To enter EOB's directly into, click "Claiming" in the menu, then drop down to click "Insurance," then click "Reporting EOBs."

To begin, providers should select from the "Search By..." drop-down menu whether they will be searching by child, patient account number, or policy number.

Providers can also enter a specific service date, a service date range, or leave these fields blank to pull up all service dates for this search. 

Click "Run" to search for claims.

All claims found by that search will then be listed to the right of the search fields. 

If "True" is listed in the "Has Denials" column, it means that the provider has entered an EOB for that claim.  If "False" is listed  along with payment or denial information, the IFA received that information electronically.  If "False" is listed and there is no payment or denial information, there is no EOB entered on the claim.

Please note that any payment on a claim, from insurance, Medicaid, or the Escrow account will be listed under the "Amount Paid" column.  When the provider clicks "Enter Paid/Denial Info" to pull up the claim at the bottom of the screen, only the amount paid by insurance is listed there.

To enter payment or denial information, click "Enter Paid/Denial Info."  The selected claim will be highlighted in the claim list, and will come up at the bottom of the screen.  Claims are broken down in lines by CPT code or resubmissions of the claim.

To enter the EOB for a claim, click "Enter Paid/Denial Info" next to a line on the claim. 

Please note that you only need to enter payment OR denial information.  If the amount paid is listed as $0.00 on the EOB, you should only enter the denial reason into

Because some insurance companies may send payment and EOB's for each CPT code of a claim separately, providers have the option to enter all payment on one CPT code listed on a claim, or to enter payment broken down by CPT code. 

When choosing a denial reason from the drop-down menu, providers should use their judgment to select a denial reason that best matches the denial listed on the EOB.  If there is not a close match, the provider can select "Other Denial Reason."

If the denial reason listed on the EOB suggests that the claim can be corrected and resubmitted, the provider should make the appropriate corrections and use the Insurance Pending Claims page to resubmit the claim.

Once the payment or denial information is entered on the claim, click "Update."

Once the information is updated, that information should be listed on the claim.

If the payment or denial information is already filled in on a claim, then the fiscal agent has already received remittances for this claim, and the provider does not need to enter or fax the EOB.

Once all of the information for an EOB has been entered, please fax that EOB to the Fiscal Agent at 1-518-836-0400. 

Please note effective December 31, 2015, PCG no longer offers an option to mail in EOB's for retention at a PCG office. As a result, EOB's received will be destroyed within 24 hours of receipt.

Updated 4/7/2017 - BF

Article ID: 87, Created On: 7/5/2013, Modified: 4/7/2017

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