The EOB/Denials tab lists all insurance payments that have been posted on the visit. The child tabs allow the user to view, add, update, and delete denial codes and create payment and denial overrides. This is used to bill secondary claims properly. The tabs allow you to work with claim-level denials (typically for inpatient claims) and service line denials (typically for outpatient claims).
The Explanation of Benefits – Payment Override tab is used to add payment or payment date override information in order to balance the account. The EOB Balance column is updated according to the payment added in this tab and claim or service line overrides added in other child tabs. The goal is to reduce the balance to zero.
To add a payment override, follow these steps:
The Claim Denial tab displays any claim denials posted with the selected payment. This read-only information can be used as a reference when attempting to override data for secondary billing.
The Explanation of Benefits Override – Claim Denial tab is used to add or update claim-level denial code information for the secondary claim.
To add a claim denial override, follow these steps:
The Service Line Detail/Denials tab displays any service-level denials posted with the selected payment. This read-only information can be used as a reference when attempting to override data for secondary billing.
The list shows each service line and its information, which includes the charge date, revenue ID, HCPCS code, quantity, charge amount, and paid amount. Click the + to expand and view the specific service line denial information, which includes the group, denial code and description, quantity, and denial amount.
The Explanation of Benefits Override – Service Line Detail/Denials tab is used to add or update service-level charge and denial code information for the secondary claim. For example, the primary and secondary insurances may have different HCPCS claim codes for charges or different CAS Reason Codes that need to be updated before rebilling the visit. This is most likely to be used for an outpatient visit.
The Line Balance column displays the charge amount less the payment and denials amounts. It should equal zero. Service lines where these amounts do not equal zero will need to be corrected.
To add a service line denial override, follow these steps:
The Denial Info window is used to add or update service-level denial code information for the secondary claim. If the user clicked the Load Claim Data button on the Explanation of Benefits Override – Service Line Detail/Denials tab, the denials will display and can be updated.
To add a service line denial, follow these steps:
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