Many Funders provide an Explanation of Benefits (EOB) document when sending payments to organizations. The EOB explains which services the payment is for. The EOB feature in Penelope enables you to enter the details from the EOB into the database. You can apply payments, make adjustments and/or apply recovery charges to the client.

To download a copy of the Create an EOB tutorial click here.


CREATE AN EOB

In this article:

Process Flow: Add an EOB

About the EOB Feature

Create the EOB

About adding a line item to the EOB

Input payment details

Add additional EOB line items

Tip: Find EOB after the fact

After you finish

Reports

Process Flow: Add an EOB

1. Create the EOB file and specify the payment method, amount, and details.

2. Add an EOB line to the EOB details using the EOB Line Wizard.

3. Filter and view the line item results.

4. Select the line item you want to provide payment details for.

5. Specify explanation, status, and adjust group codes if desired.

6. Choose a payment detail option.

7. Specify payment details as needed.

8. Repeat steps 2-7 until you’ve completed your EOB.

About the EOB feature

THE BASICS

Many funders provide an Explanation of Benefits (EOB) document when sending payments to organizations. The EOB explains which services the payment is for. The EOB feature in Penelope enables you to enter the details from the EOB into the database. You can apply payments, make adjustments, and/or apply recovery charges to the client.

Create the EOB

STEP 1

On your homepage, in the Links sidebar, click Create EOB.

STEP 2

a) In the Reason drop-down list, select the payment method or type.

b) In the Date field, select the date of payment.

c) In the Total field, type the total payment amount.

d) In the Check No field, type the check or transaction number if applicable.

e) In the Description field, type a description of the payment.

f) In the Received by Site dropdown list, select the site the payment was received at. g) If applicable, on the Add to Deposit drop-down list, select which deposit you want to add the payment to.

h) Click Save.


About adding a line item to the EOB

THE BASICS

The Detail section in the EOB includes the Add feature for adding individual line items to the EOB. The Detail section will subsequently list the payment details as you have entered them in the database. The Totals section displays a running total of the EOB payment amount, how much has been applied, and the remaining unapplied balance.

add a line item to the eob

STEP 1

In the Detail section, click Add.

STEP 2 In the View By section, choose at least two fields including Funder to filter the search results.

STEP 3 Click View. Note: Search results are limited to the first 500 lines matching the filter criteria. If you do not see the line item that you are expecting, include additional search criteria in the View By section.

STEP 4 In the results, select the appropriate line item for which you want to enter EOB details.

Input payment details

Additional Input Payment Details:

Payment

Denied

Debit Adjustment

Return Units

Recover Units

STEP 5

If desired, in the Explanation Code section, type the explanation code as provided by the funder.

STEP 6

If desired, in the Status Code dropdown list, select the status code as provided by the funder.

STEP 7

If desired, in the Adjust Group Code drop-down list, select the adjust group code as provided by the funder.

STEP 8 In the Payment Details section, select the appropriate option.

STEP 9 Depending on the Payment Details option that you select, click Next or Finish. Note: Depending on the Payment Details option you select, your next steps will vary. The following slides walk you through how to input payment details for each option.

Input payment details: Payment

STEP 1

In the Amount Received field, confirm or type the total amount received for the line item.

STEP 2

To apply the payment, click Finish.

Input payment details: Denied (No adjustment)

Note: After clicking Finish, no further action is required.

input payment details: credit adjustment

Note: The Amount Received field is automatically populated with the total invoiced amount. When you adjust this to the actual amount paid by the funder, the Amount of Credit line will adjust accordingly so the two amounts equal the Invoiced Total.

STEP 1 a) In the Amount Received field, type the total payment received. b) In the Amount of Credit field, verify the credit amount. c) In the Reason drop-down list, select the reason for the credit. d) If required, in the Description field, type a description. e) In the Issued at Site drop-down list, select the site the credit will be issued from. f) In the Service drop-down list, select the Case Service the credit will be associated with. STEP 2 To apply the payment and credit, click Finish.

Input payment details: Debit Adjustment

Note: The Amount Received field is automatically populated with the total invoiced amount.

STEP 1 a) In the Amount Received field, type the total payment received. b) In the Amount of Debit field, verify the debit amount. c) In the Reason drop-down list, select the reason for the debit. d) If required, in the Description field, type a description. e) In the Service drop-down list, select the Case Service the debit will be associated with. STEP 2 To apply the payment and debit, click Finish.

Input payment details: Return Units

Note: The Units to be Returned field is automatically populated with the original quantity invoiced. If required, you can adjust the quantity if the funder paid for some but not all of the quantity charged. The Amount Received field is set to 0.00 by default. If this amount is changed, the Amount Remaining field automatically updates to reflect the difference between the invoiced and received amounts. A partial return (where some but not all of the service units were paid) can be recorded by entering the quantity of service units not paid for and the payment amount received for the units that were paid.

STEP 1 a) In the Units to be returned field, confirm or type the number of units to be returned to the policy. b) In the Amount Received field, confirm or type the amount received. STEP 2 To apply the return, click Finish.

Input payment details: Recover Units

Note: The number of service units being recovered (i.e. returned to the policy) will default to the original quantity invoiced. You can adjust this value if the funder paid for some but not all of the units charged. If the service unit was covered by a policy, then the unit(s) and/or dollar amount(s) will become available for use again. The Amount Received field is set to 0.00 by default. If this amount is changed, the Amount Remaining field automatically updates to reflect the difference between the invoiced and received amounts. If a payment was previously applied to the invoiced service unit(s), it will become an unapplied payment. The Adjustment amount (the amount being recovered and charged to the client) automatically updates to reflect the difference between the invoiced amount and the amount paid by the funder. If a client was charged a Co-Pay, it will be credited back and included in the adjustment amount being recharged to the client.

STEP 1 a) In the Units to be recovered field, confirm or type the number of units you want to recover from the funder and charge to the client. b) In the Amount Received, confirm or type the payment received. c) In the Reason drop-down list, select the recovery reason. STEP 2 To apply the recovery, click Finish.

Add additional EOB line items

Continue adding all of the line items as they show up on the EOB provided by your Funder.

Note: The Invoice Number filter is “remembered” for the duration of your browser session when adding multiple lines to an EOB

The Totals section displays a running total of the EOB payment amount, how much has been applied, and the remaining unapplied balance. As you add in the line items, you can ensure your totals match up and that the EOB has been fully applied.

Tip: Find the EOB after the fact

If you need to find the EOB after the fact to continue adding line items, review, or make adjustments, you can use the Search feature to locate the EOB.

STEP 1 In the Search feature, on the Billing tab, click EOB.

STEP 2 If required, type any Search Criteria.

STEP 3 Click Go.

STEP 4 In the Results section, click the appropriate EOB ID.

After you finish

DOCUMENTS

On the Documents tab on the EOB page, you can see a summary of all the Documents associated with the EOB including invoices, payments, recoveries, returns, credits, and debits.

REPORTS

The EOB Detail Report includes a summary of all information entered for the EOB. To see a printed copy of the EOB, click the Print option.

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