--- You wrote:
I have a question regarding Explanation of Benefits in an 837 environment.  

"Provider submits an 837 claim to Payer A. Payer A sends back an 835
electronic remit.  Balance to Payer B has to be submitted on a paper
claim form. (for whatever reason)  Payer B requires that an explanation of benefits is 
sent along with the claim.  What does the provider send to Payer B if there is no 
hardcopy of the 835 remit?"
--- end of quote ---

We have addressed the issue you bring up. Even though we have (for now) paper remits 
in addition to the electronic versions from our "payer A's", we worked out a process 
to create an EOB from the data so we would not have to go through the arduous task of 
making and matching copies to paper claims. We produce a claim and an EOB for each 
patient as part of our secondary claim runs. 

We created a paper version of the EOB that is nearly identical to the PCPrint format 
that Med A provides to create paper docs from their files. Our thought was that payers 
are already familiar with this layout and were more likely to find it acceptable this 
way. When asked, we've explained that the paper version is created from the data file, 
just as we do with medicare. This has been almost universally accepted by our "payer 
B's".

-Chris Healy
Dartmouth-Hitchcock Medical Center
PFS-Billing Support Mgr
603-650-3730


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