The Explanation of Payment (EOP) provides detail on claims that have been paid, denied or adjusted. A separate EOP is issued for each Line of Business.
The following tables display descriptions of the information provided on an EOP:
Payments are made to hospitals and providers weekly.
To resolve/research a denied claim appearing on an EOP, please reference the two-digit denied explain code and any related instructions, (i.e. incorrect patient information, obtain the appropriate referral, bill another carrier).
It is important to note that a negative balance may occur, when a previously paid claim is adjusted. The negative balance will continue to be reflected on future EOP’s, until the entire balance is cleared.
For questions related to understanding your Explanation of Payment, contact the Customer Service Department at (800) 332-9161.