3 Reasons Why Your Biller Needs to See Your EOBs (Explanation of Benefits)

Main Points

Your biller needs your EOBs so they can follow up on denials in a timely fashion
Your biller needs your EOBs so they can make sure the insurance companies are paying you what you deserve to be paid
Your biller needs your EOBs so they can reconcile your A/R

There can be some concerns about sending EOBs through email or through an encrypted portal. It is reasonable to be concerned about data breaches, stolen personal data, or HIPAA non-compliance. However, it is very important that your biller has regular access to your practice's EOBs.

One of the reasons why your biller needs access to your patient's EOBs is so they can follow-up on claims in a timely fashion as to avoid a timely filing denial.

Definition: Timely filing denials occur because an insurance company puts a time limit on claims submission. If a payer has a 90 day timely filing requirement, that means you have to submit the claim within 90 days of the date of service.

Pro-tip: Medicaid has a 95 day timely filing requirement, Medicare has a 365 day timely filing requirement, and Cigna has a 90 day timely filing requirement

Because you want to avoid any timely filing denials, you will want to communicate or send those EOBs to your biller as soon as possible.

The other reason your biller needs access to your EOBs is to make sure the insurance companies are paying you the rate you agreed to.

All too often insurance companies make mistakes. One of the mistakes that is made is either underpaying for the service or overpaying for the service.

If an insurance company underpays you, then they owe you the rest of the money for the session.

If an insurance company overpays you, then they will probably ask for a recoupment of that money. Meaning that you have to cut them a check or they will deduct the over payment from future payments.

This can be problematic especially if cash flow is tight. Therefore, you will want to make sure that you are paid everything that you are owed.

The last reason your biller needs access to your EOBs is so they can reconcile the A/R of the practice. In our previous blog post, we discussed the fact that A/R is the measure by which billing is considered successful or unsuccessful.

If you have payment and your biller doesn't have access to your EOBs that could mean that your A/R is not accurately represented.

You will want to make sure you are keeping accurate and good records for your practice in case you are audited or need to review your claims.