According to our Provider Customer Service teams, callers often ask how the following terms are used. So, while we are letting you know how easy it is to find the EOP/Remit documents, we are including these definitions too:
Coordination of Benefits (COB) ‐ When a member is covered by more than one benefit plan, with both providing similar benefits, EmblemHealth coordinates with the other carrier to ensure appropriate reimbursement.
Electronic Funds Transfer (EFT) ‐ A process that allows the health plan to directly deposit payments into the provider’s bank account.
Electronic Remittance Advice (ERA) ‐ An electronic version of the Explanation of Payment sent to providers who have registered to receive EFT/ERA through our partner ECHO. Providers can download their ERAs from our Provider Portal.
Explanations of Benefits (EOB) ‐ A form sent to the enrollee after a claim for payment has been processed by the health plan. The form explains the action taken on that claim. This explanation usually includes the amount paid, the benefits available, reasons for denying payment and the claims appeal process.
Explanations of Payment (EOP) ‐ A form sent to providers after a claim for payment has been processed by the health plan. It is also referred to as a remittance advice or remit. Copies of the EOPs can be downloaded from our Provider Portal.
The explanation details how the claim was adjudicated and shows the member’s actual cost share, if any, due to a deductible, copay, or coinsurance requirement. The EOP will also show if there are any Coordination of Benefits (COB) requirements such as the need for the provider to submit the Explanation of Benefits or Explanation of Payment from the Primary Payor (e.g., CMS or another health plan) in order for accurate reimbursement to be determined.
Remittance Advice (Remit) ‐ This term can be used interchangeably with Explanation of Payment. We have partnered with ECHO to offer Electronic Remittance Advices (ERA) along with Electronic Funds Transfer (EFT). We strongly recommend that our providers sign up for EFT/ERA to streamline claims payment.
