EOBs explain what services were covered, the allowed amount, what was paid, and what the patient may owe (copay/deductible). They are not bills, but they guide payment posting and follow-up.
Billing teams review EOBs (or their electronic equivalent - Electronic Remittance Advice (ERA) files, commonly referred to as 835 files) to identify underpayments or denials. Integrated systems match EOB data with claims automatically to speed up reconciliation.
Why it matters:
EOBs provide visibility into payer behavior. They tell you if you are being paid correctly according to your contract.
Pro Tip:
If you are manually reading paper EOBs, you are working too hard. Delays in reviewing EOBs make underpayments harder to recover due to payer filing and appeal deadlines.
FAQ
- Is an EOB the same as a bill? No. EOBs explain coverage and processing. The actual bill is sent by the provider to the patient for any balance due.
- Why does the EOB say "Patient Owes" more than my copay? This usually happens if the deductible hasn't been met yet or if a specific service wasn't covered.
- How long should I keep EOBs? Clinics should retain these records for several years (commonly 7 but sometimes, but sometimes longer depending on state and payer requirements) for audit purposes, though digital storage is preferred.
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