There for you, 24/7/365
Explanations of Payments (EOPs) in Provider Portal
TABLE OF CONTENTS
Try using our provider portal to find Explanations of Payments (EOPs)
Provider Portal Survey
Definitions
Want to learn about other portal features?
Still don't have a portal account?
Try using our provider portal to find Explanations of Payments (EOPs)
No more waiting for the mail or checking two websites! Seeing how we processed your claims is simple when you use our provider portal. Not only can you view the information online, or in an Excel report format, but you can also obtain copies of your Explanations of Payment (EOPs) for both EFT/ERA and paper claims for the last 24 months.
There are four (4) ways to look up your EOPs:
- Check Number
- EFT Number
- Client Reference ID
- Date of EOP Remittance
Once you have found the one you want to see, you may either download the Remit or a Payment Summary.
It’s that easy!
If you want step-by-step instructions, see: An overview of how to search for an Explanation of Payment (EOP)
EmblemHealth: View PDF or View Video.
ConnectiCare: View PDF or View Video.
Provider Portal Survey
Our goal is to make the Provider Portal valuable to your practice. Take our short survey and tell us how we can make the portal better for you. The survey is located at the top of the Provider Portal Home page.
Take EmblemHealth Portal Survey Now
Definitions
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.
Want to learn about other portal features?
Whether you’re a first-time user who needs to set up an account, or a regular user who wants to learn how to do more, we have videos, step-by-step guides, and Frequently Asked Questions (FAQs) to help you:
Still can’t find what you need? If you have a portal account, please use the Message Center to send us your questions. If the question is urgent or too complicated to write out, please call our Provider Customer Service team at:
- EmblemHealth: 866-447-9717
- ConnectiCare: Commercial: 860-674-5850, Medicare: 877-224-8230
Still don’t have a portal account?
If you need portal access, your organization’s portal Administrator/Office Manager can set you up. In support of HIPAA compliance, we are looking to our providers to manage their own users. If your organization itself needs to set up a master account for a new Tax ID, contact our Provider Customer Service team at:
- EmblemHealth: 866-447-9717
- ConnectiCare: Commercial: 860-674-5850, Medicare: 877-224-8230
EmblemHealth Provider Portal Claims EOPs
/content/dam/emblemhealth/pdfs/provider/portal/claims/EmblemHealth-Provider-Portal-Claims-EOP.pdf
ConnectiCare Claims Search EOPs
/content/dam/connecticare/pdfs/providers/training/portal-resources/claims/ConnectiCare-Provider-Portal-Claims-EOP.pdf
ALSO OF INTEREST
Find a doctor or medical office
Find a doctor or medical office
myEmblemHealth Member Portal
Language Assistance:
© 2020 EmblemHealth. All Rights Reserved.
Any information provided on this Website is for informational purposes only. It is not medical advice and should not be substituted for regular consultation with your health care provider. If you have any concerns about your health, please contact your health care provider's office.
Also, this information is not intended to imply that services or treatments described in the information are covered benefits under your plan. Please refer to your Membership Agreement, Certificate of Coverage, Benefit Summary, or other plan documents for specific information about your benefits coverage.